Cities, Health and Wellbeing: Global Governance and Intersectoral Policies (Sustainable Urban Futures) 3030893472, 9783030893477

Table of contents :
Contents
About the Author
Abbreviations
List of Figures
1 Introduction
Motivation
Objectives and Scope
Theoretical Framework. Epistemological Framework in the Realm of Economics and Public Policy. “Economics Above Politics”/ “Politics Above Economics”
Research Question
Methodology
References
Part I Multilevel and Sectoral Policies
2 Introduction. How Multilevel Governance Affects Spatial Planning and Health
The 2030 Agenda. Distinction Between Binding and Nonbinding Legal Instruments
From Principles to Laws: Compliance, Implementation and Effectiveness
Nonbinding Instruments: Opportunities and Challenges for Health and Urban-Related Policies
References
3 Health
Health EU
DG SANTE and the European Semester
EU Health Programmes (2003–2020) and the EU4Health (2021–2027) Turning Point
European Semester Recommendations (2010–2019)
Health PT
To Compare Health Guidelines Before 2004
Changes and Priority Areas Introduced by the First National Health Plan (2004–2010)
The Ongoing National Health Plan (2012–2016) and the First National Plan for Mental Health (2007–2016) Both Extended Up Until 2020
Conclusion (Tensions and Solutions)
References
4 Spatial and Urban Planning
Spatial and Urban Planning in the European Union
EU Cohesion as Regional Policy, from the Treaty of Rome (1958) up Until 2007
The Emergence of “Territorial Cohesion” in Key EU Documents in the Midst of the 2008 Financial Crisis, 2007–2009
From an EU Cohesion Policy Based on Regional Cohesion to an Urban-Centred Cohesion Policy, Since 2009
Spatial and Urban Planning in Portugal
Grassroots Spatial Planning: Brief Account from the Nineteenth Century up Until 2007
A First Attempt to Articulate an Institutional and Legal National Spatial Planning Strategy (PNPOT 2007–2017 and Basic Law for Soil, Spatial Planning and Urbanism Public Policies, 2014 and 2017)
Towards a New Territorial Culture: Administrative Territories; PNPOT, 2020 (2020–2030); Governance Systems to Articulate National, Regional and Local Levels, Since 2017
Conclusion (Tensions and Solutions)
References
5 Health and Urban Planning. Growing Convergence of Health and Spatial Planning Policies
References
Part II Policy Coordination and Intersectoral Action
6 Introduction. Increasing Role of Joint Health and Spatial and Urban Planning Policies
Spatial and Urban Planning as a Vaccine. The Case of the COVID-19 Pandemic
Mapping Impact: Health, and Spatial and Urban Planning Policies
Recent Intersectoral EU Policy in Portugal
References
7 2030 Agenda
Brief Review of Previous Strategies and How They Address Health and Cities
Indicators: To Evaluate Implementation. Advantages and Disadvantages of Indicators Associated with “Goals” Instead of “Rules/Laws”. Up to What Extent it is Possible to Translate Abstract and Universal Principles to the National Scale. Is This Strategy Effective?
To Identify the Advantages of a Multi-Criteria Statistical Method that Assesses Several Indicators Simultaneously—Being the Most Adequate Method to Monitor an Initiative that Defines Goals
To Present the Process of Creating Indicators and Indexes in Portugal Concerning SDGs
References
Part III On Indicators
8 Designing a Set of Indicators Addressing SDGs, Health and Urban National Policies
Coupling Between SDGs, Health and Urban National Policies
Governance, Administration and Management Challenges: Process (Efficient, Outputs) and System (Effective, Outcomes)
Proposal of a Set of Indicators Addressing SDGs, Health and Urban National Policies
References
9 Conclusion
References

Citation preview

SUSTAINABLE URBAN FUTURES

Cities, Health and Wellbeing Global Governance and Intersectoral Policies Diana Soeiro

Sustainable Urban Futures

Series Editors Zaheer Allam, Le Hochet, Morcellement Raffray, Terre-Rouge, Mauritius Sina Shahab, School of Geography and Planning, Cardiff University, Cardiff, UK

This series includes a broad range of Pivot length books offering accessible and applied texts designed to appeal to both practitioners and academics in the field. Pivots in the series will explore how sustainability can be achieved in Future Cities and how technology can assist in supporting sustainable transitions to better respond to the urgencies of climate change, equity needs and inclusivity aligning the two core themes of Urban Science and Future Science.

More information about this series at https://link.springer.com/bookseries/16631

Diana Soeiro

Cities, Health and Wellbeing Global Governance and Intersectoral Policies

Diana Soeiro DINÂMIA’CET-IUL Centre for Socioeconomic and Territorial Studies ISCTE-University Institute of Lisbon Lisbon, Portugal

ISSN 2730-6607 ISSN 2730-6615 (electronic) Sustainable Urban Futures ISBN 978-3-030-89347-7 ISBN 978-3-030-89348-4 (eBook) https://doi.org/10.1007/978-3-030-89348-4 © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cover illustration: © Melisa Hasan This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

To my inspirational parents To my two dogs, Gui and Manolo, and Eduardo for his Friendship

Contents

1

Introduction Motivation Objectives and Scope Theoretical Framework. Epistemological Framework in the Realm of Economics and Public Policy. “Economics Above Politics”/ “Politics Above Economics” Research Question Methodology References

1 1 2

5 8 8 10

Part I Multilevel and Sectoral Policies 2

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Introduction. How Multilevel Governance Affects Spatial Planning and Health The 2030 Agenda. Distinction Between Binding and Nonbinding Legal Instruments From Principles to Laws: Compliance, Implementation and Effectiveness Nonbinding Instruments: Opportunities and Challenges for Health and Urban-Related Policies References Health Health EU

15 15 16 20 22 23 23

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CONTENTS

DG SANTE and the European Semester EU Health Programmes (2003–2020) and the EU4Health (2021–2027) Turning Point European Semester Recommendations (2010–2019) Health PT To Compare Health Guidelines Before 2004 Changes and Priority Areas Introduced by the First National Health Plan (2004–2010) The Ongoing National Health Plan (2012–2016) and the First National Plan for Mental Health (2007–2016) Both Extended Up Until 2020 Conclusion (Tensions and Solutions) References

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Spatial and Urban Planning Spatial and Urban Planning in the European Union EU Cohesion as Regional Policy, from the Treaty of Rome (1958) up Until 2007 The Emergence of “Territorial Cohesion” in Key EU Documents in the Midst of the 2008 Financial Crisis, 2007–2009 From an EU Cohesion Policy Based on Regional Cohesion to an Urban-Centred Cohesion Policy, Since 2009 Spatial and Urban Planning in Portugal Grassroots Spatial Planning: Brief Account from the Nineteenth Century up Until 2007 A First Attempt to Articulate an Institutional and Legal National Spatial Planning Strategy (PNPOT 2007–2017 and Basic Law for Soil, Spatial Planning and Urbanism Public Policies, 2014 and 2017) Towards a New Territorial Culture: Administrative Territories; PNPOT, 2020 (2020–2030); Governance Systems to Articulate National, Regional and Local Levels, Since 2017 Conclusion (Tensions and Solutions) References

55 55

Health and Urban Planning. Growing Convergence of Health and Spatial Planning Policies References

25 30 34 34 37

41 44 49

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CONTENTS

Part II 6

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Policy Coordination and Intersectoral Action

Introduction. Increasing Role of Joint Health and Spatial and Urban Planning Policies Spatial and Urban Planning as a Vaccine. The Case of the COVID-19 Pandemic Mapping Impact: Health, and Spatial and Urban Planning Policies Recent Intersectoral EU Policy in Portugal References 2030 Agenda Brief Review of Previous Strategies and How They Address Health and Cities Indicators: To Evaluate Implementation. Advantages and Disadvantages of Indicators Associated with “Goals” Instead of “Rules/Laws”. Up to What Extent it is Possible to Translate Abstract and Universal Principles to the National Scale. Is This Strategy Effective? To Identify the Advantages of a Multi-Criteria Statistical Method that Assesses Several Indicators Simultaneously—Being the Most Adequate Method to Monitor an Initiative that Defines Goals To Present the Process of Creating Indicators and Indexes in Portugal Concerning SDGs References

Part III

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101 101 104 110 116 119 119

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On Indicators

Designing a Set of Indicators Addressing SDGs, Health and Urban National Policies Coupling Between SDGs, Health and Urban National Policies Governance, Administration and Management Challenges: Process (Efficient, Outputs) and System (Effective, Outcomes) Proposal of a Set of Indicators Addressing SDGs, Health and Urban National Policies References

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Conclusion

References

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About the Author

Diana Soeiro (Philosophy, Ph.D. and Economics and Public Policy, PostGrad) Scientific Writer and Policy Analyst. She conducted her Postdoctoral studies in Philosophy and Urban Studies (Nova University of Lisbon, 2012–2018) funded by Fundação para a Ciência e a Tecnologia (FCT) having lectured several MA level courses in the English language between 2015 and 2018. She was Postdoctoral Researcher at the project ROCK—Regeneration and Optimization of Cultural heritage in creative and Knowledge cities (2017–2020), funded by the European Union under Horizon 2020. In 2017 she was appointed Ambassador for United Nations’ 2030 Sustainable Development Goals Agenda (United Nations, Global Compact Network, Portugal) acknowledging the relevance of her skills to promote positive change concerning SDG 11 (Sustainable Cities and Communities), SDG 3 (Good Health and Well-Being) and SDG 16 (Peace, Justice and Strong Institutions). She is affiliated with DINÂMIA’CET-IUL—Centre for Socioeconomic and Territorial Studies, ISCTE—University Institute of Lisbon (ISCTE-IUL). Recently she authored: “The Concept of Atmospheres: From Goethe to Bratton— How Atmosphere Is Key to Creating Smart Cities” (2020), in Reconstructing Urban Ambiance in Smart Public Places (eds. H. Abusaada, A. M. Salama & A. Elshater) IGI Global, DOI: https://doi.org/10.4018/ 978-1-7998-3856-2.ch002; and “Smart Cities, Well-being and Good

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Business: The 2030 Agenda and the role of knowledge in the era of Industry 4.0” (2020) in Knowledge, People and Digital Transformation: Approaches for a Sustainable Future (eds. F. Matos, V. Vilarinhos, I. Salavisa, L. Edvinsson & M. Massaro) Springer Nature, DOI: https:// doi.org/10.1007/978-3-030-40390-4.

Abbreviations

ARS CCDR CEMAT DG REGIO DG SANCO DG Sante DGS DGT EC EEC EGD ERDF ES ESDP ETC EU INE LBOTU MDGs NCDs NHS NPMH OECD PHP PNPOT

Regional Administration for Health Regional Coordination and Development Committee Conference of Ministers Responsible for Spatial/Regional Planning Directorate-General for Regional Policy Directorate-General for Health and Consumers Directorate-General—Sante Directorate-General for Health Directorate-General for Territory European Commission European Economic Community European Green Deal European Regional Development Fund European Semester European Spatial Development Perspective European Territorial Cooperation European Union Statistics Portugal Basic Law for Spatial and Urban Planning Millennium Development Goals Non-Communicable Diseases National Health System National Plan for Mental Health Organisation for Economic Co-operation and Development Public Health Programme National Program for Spatial Planning Policy xiii

xiv

ABBREVIATIONS

RAN REGI Committee REN SDGs TAEU 2030 UD/MD UN VUCA WHO

National Ecological Reserve European Parliament Committee on Regional Development National Agrarian Reserve Sustainable Development Goals Territorial Agenda of the EU 2030 Centre for Urban Design and Mental Health United Nations Vulnerable, Uncertain, Complex and Ambiguous World Health Organization

List of Figures

Fig. 1.1

Fig. 1.2 Fig. 4.1 Fig. 4.2 Fig. 4.3

Fig. 5.1

Fig. 7.1 Fig. 7.2 Fig. 8.1

2030 Agenda. United Nations. Available at: https://www. un.org/sustainabledevelopment/news/communicationsmaterial/ Roe and McCay (2021). No copyrights EU cohesion policy and regional policy (Elaborated by the author) EU Spatial and Urban Planning Policies. (Elaborated by the author) By the author. Spatial and Urban Planning legal instruments according to LBOTU, 1998. Based on Oliveira (2009, pp. 109, 110) OECD (2021). Better life index. Accessed August 30, 2021. https://stats.oecd.org/Index.aspx?DataSetCode= BLI# Gamper and Turcanu (2007, p. 305) SMCE process by steps. Etxano and Villalba-Eguiluz (2021) The role of spatial and urban planning

3 6 56 57

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93 127 128 148

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CHAPTER 1

Introduction

Motivation For decades to come, the world’s two main challenges will be climate change and mental health. Urbanisation is a key factor to address both. Climate change and the COVID-19 pandemic have contributed to acknowledging that the convergence between health and spatial and urban planning policies is needed. Even before the pandemic, the European Green Deal (EC-EGD, 2021), launched by the European Commission, aimed to promote policy initiatives to make Europe climate neutral in 2050, included several plans to address health concerns, lifestyle and urban sustainability strategies. The 2015 Paris Agreement was also a significant initiative that asserted the urgency of climate change, affirming its life-threatening qualities to humanity. Cities occupy 3% of the Earth’s land but account for 60 to 80% of energy consumption and at least 70% of carbon emissions. Just over half the world’s urban greenhouse gas emissions come from 25 mega-cities— out of which 23 are located in China though the country has agreed to reduce carbon emissions by signing the 2015 Paris Agreement (OGC, 2021; Wei et al., 2021). According to Marcantonio et al. (2021), toxic pollution is a key driver of climate change resulting in the death of more than 8 million people annually with materials emitted into the air, water or land, negatively © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 D. Soeiro, Cities, Health and Wellbeing, Sustainable Urban Futures, https://doi.org/10.1007/978-3-030-89348-4_1

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impacting health. The situation generates several phenomena equally dangerous like global warming, land degradation, extreme weather events and sea-level rise. Low-income countries face relatively higher risks from toxic pollution and climate change than high-income countries. It is also known that toxic pollution causes cognitive dysfunction and chronic respiratory illnesses. The number of annual global deaths resulting from high pollution is yet undetermined, but between 2030 and 2050, an additional 250,000 people are estimated to perish annually. “The social outcomes and costs associated with these risk factors are as far-reaching as the biogeophysical outcomes. The estimated current economic output lost due to the human health effects of toxic pollution is $4.6 trillion annually or 6.2% of global GDP. The estimated current economic productivity losses from global warming, in just the US and the EU, is $4 trillion. By 2100 world GDP per capita is expected to be reduced by 7.2% due to climate change”. Literature strongly suggests that other indirect effects from climate change include increased incidence of mental health issues (Berry et al., 2010; Bourque & Willox, 2014; Cunsolo Willox et al., 2015; Willox, 2013). Given this scenario, it is urgently necessary to create and implement public policies that simultaneously address and positively impact health and spatial and urban planning. More so, as I will demonstrate below, in Asia and Africa, where large-scale new cities are being built, bringing added health challenges and questioning traditional urban models.

Objectives and Scope In health and spatial and urban planning, there is a call for intersectoral cooperation at the international, European, and national levels. This kind of interaction in public policies is encouraged by the United Nations 2030 Agenda (2015) that establishes 17 Sustainable Development Goals (SDGs) (see Fig. 1.1, United Nations 2030 Agenda). To make the most of available resources, policies that address more than one sector simultaneously bring benefits at a lower cost. Nevertheless, to design intersectoral policies, there need to be mechanisms that allow for collaboration to occur. This requires a flexible, transparent and coherent institutional framework. What is Portugal’s current multilevel institutional framework, and how can it better support dialogue across sectors—particularly between health and spatial and urban planning?

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Fig. 1.1 2030 Agenda. United Nations. Available at: https://www.un.org/sus tainabledevelopment/news/communications-material/

The overall perspective of this book is policy-oriented, and in particular, it addresses institutional and political frameworks. Taking Portugal’s case study provides a scientifically informed diagnosis, covering two main sectors (health and spatial and urban planning) and five governance levels (international, transnational/European, national, regional and local) dealing with many different sources of information. Public policy design comprises six stages: research, analysis, options, consultation, proposals and decisions. In practice, this simple sequential model rarely happens with some steps coming in the wrong order or some being omitted (Wilson, 2006, p. 152). However, this cycle is only relevant if relevant stakeholders already identified a particular need. On the one hand, the need for institutional cooperation between health, and spatial and urban planning was acknowledged at transnational/European and national level in broad terms. On the other hand, science and research have been increasingly confirming the link between both. Still, in practice, cooperation that results in a collaborative design, implementation and monitoring of policies highly depends on context. In turn, context is also essential to account for potential constraints that may block cooperation.

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Therefore, concerning its objectives and scope, it is essential to state three premises: 1) This book aims to present an analysis that anticipates the need for health and spatial and urban policies tailored to a specific context. To facilitate the first three stages of a public policy cycle, I provide a detailed multilevel and intersectoral analysis taking Portugal’s case study. Being an EU Member State and having subscribed to the 2030 Agenda this book contains a lot of helpful information that allows both for an in-depth perspective of the Portuguese context and the EU context concerning both health and spatial and urban sectors; 2) Intersectoral policies require interdisciplinary evidence so that decision-making can be informed. I rely on existing evidence-based research to support the link between the two sectors; 3) The 2030 Agenda is an excellent opportunity to rethink current governance systems due to its policy integration approach, where each goal connects with several others. The interwovenness of goals, if addressed by specific public policies, favours an intersectoral approach, more resilient to an increasingly vulnerable, uncertain, complex and ambiguous (VUCA) world. This is why it is critical to make current systems more flexible and adaptable. The increasing role of transnational and international institutions on national governance systems requires integrating multiple actors and resources at various scales in a given national governance system. Though briefly addressed, bottom-up and top-down approaches, i.e. the interaction between institutions and citizen participation, are out of scope in this book. However, they are highly relevant and addressed by a significant body of literature. I privilege institutions, systems and processes, adopting a critical perspective of increasingly complex governance systems, identifying opportunities and obstacles. Aware of the limitations to conduct a fully comprehensive analysis of all relevant documents, the goal of this book is to provide a “robust enough” research and analysis that allows one to foresee different options able to bridge the gap between broad agenda-setting documents and

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specific place-based strategies; between the interdisciplinary and the intersectoral; between higher and lower governance levels—from theory to practice. Taking the 2030 Agenda as an opportunity, it aims at combining this objective with a suggestion of metrics/indicators to be adopted in Portugal in health and spatial and urban planning.

Theoretical Framework. Epistemological Framework in the Realm of Economics and Public Policy. “Economics Above Politics”/ “Politics Above Economics” The theoretical framework that sustains the link between urban agglomeration and mental health has been fast growing in the last decade. Among pioneers who have acknowledged this subject as a research topic is Dr Layla McCay, psychiatrist and international public health systems specialist, founder of the think tank Centre for Urban Design and Mental Health (UD/MH), back in 2015. She recently co-authored a book with Dr Jenny Roe, environmental psychologist, titled Restorative Cities (2021), conducting a wide-ranging literature review that supports the link between urban design and mental health. In it, we find a comprehensive framework that encompasses several aspects covered by literature addressing the potential of urban design to contribute to mental health positively. This framework embodies the vision that this book has in mind when it comes to finding the best possible strategy, policy-wise, to implement, monitor and evaluate according to UD/MD’s motto “to design better mental health into cities”. The framework includes seven main elements (see Fig. 1.2, Restorative Cities framework, no copyrights). The epistemological framework of this book lies in the interaction between economics and public policy. According to a United Nations (2018) report, in 2007, the global urban population exceeded the global rural population for the first time in history. In 2008, the global urban population was 55% (2018), and it is expected that up until 2050, it will reach 68% showing an average annual growth rate of 1.9%. However, developing countries will contribute the most to the increase, with an average yearly growth rate of 3.9%. The high growth rate of the urban population in developing countries is expected to be associated with an increase in construction. It is welldocumented that construction is one of the most significant short-term

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Fig. 1.2 Roe and McCay (2021). No copyrights

drivers to increase a country’s GDP, sparking economic growth (Lewis, 2009). However, it has also been established that added expansion of the construction industry beyond the adaptive capacity of the economy will become wasteful of national resources (Giang & Pheng, 2011). Particularly in the early 2000s, China’s economic growth was significantly based on constructing large cities across its territory (Yu, 2014). This has led to a boom in the construction of new cities. According to Dr Sarah Moser (McGill University, Canada), new cities are “urban mega-projects that are intended to be largely independent of existing cities and have their industries. They are physically separate from existing settlements, in contrast to suburbs or gated communities” (Shepard, 2017). Some of them, exceeding demand, and having low access to amenities, remain empty, waiting for inhabitants. In China, new construction built in the last five years has the highest vacancy rates, being only partially occupied—if at all (Williams et al., 2019). The social and ecological impact

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of these “ghost cities” is known to be high (He et al., 2016). Between 2008 and 2012, at least 28 ghost cities/towns were documented within 16 provinces, with severe effects on land use and the ecosystem, creating a waste of resources and energy (Guizhen et al., 2016). Acknowledging past approaches in 2014, China issued the “National New-type Urbanization Plan (2014–2020)”. Among its goals to address existing misuse of urban land are to encourage green production and green consumption as the mainstream of urban lifestyle, to improve urban infrastructure and to reduce regional disparities in terms of spatial distribution and scale structure (Wang et al., 2015). Nonetheless, the “new cities” phenomenon exists in several other countries and may include new cities and mega infrastructures. A lot of research in recent years has been fast developing on the emergence of Sino-African megaprojects in African territory, investigating megaprojects like the Addis Ababa-Djibouti Railway (Ethiopia/ Djibouti), Merowe Dam (Sudan) and Nova Cidade de Kilamba (Angola) (Reboredo, 2021). Over a dozen countries in Africa are constructing more than 70 “new cities” from scratch, particularly as part of China’s Belt and Road Initiative, including some other powerful foreign actors from emerging economies (Moser et al., 2020). Both in Asia and Africa, the number and the scale of cities are astounding compared to Western standards. For example, Malaysia’s Forest City in Singapore has the capacity to accommodate 700,000 inhabitants being four times the size of Central Park (over 13 square kilometres). China’s Binhai New Area, featuring two new financial districts, a high-tech zone, an eco-city and an expanded port, weighs in at 2,270 square kilometres, which is around the same size as Tokyo (Shepard, 2017). In the past two decades, over 150 new cities (excluding China) built from scratch have been launched in more than 40 countries, located almost exclusively in emerging economies (Moser & Côté-Roy, 2020). Three main questions emerge that require further research concerning this phenomenon of “new cities” and megaprojects worldwide, particularly in developing countries. The first is, who are these cities for? Fostering rhetoric of seduction among the elites, these new developments are hardly accessible to the poor and middle class being expected to deepen further the inequality gap (Côté-Roy & Moser, 2018; Shepard, 2017). The second question is, are new urban models being used to build these “new cities”. If so, which are they introducing local adaptations (Hanakata & Gasco, 2018; Moser et al., 2020)? The third question is, are

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these models resilient and economic, social and ecologically sustainable long term?

Research Question Both the scale and density of urban agglomerates have become increasingly prevalent worldwide. Urban models predominantly sustained by grey infrastructure, where built environment and mobility propelled by car use are the dominant elements, need to be reviewed and updated. Acknowledging climate change and mental health as the two most pressing challenges and aiming at promoting a new urban model that is both sustainable and resilient long term, how can we make sure we are walking towards that goal? Using the 2030 Agenda framework that embodies a worldwide consensus of a sustainable world, how can we enounce, create, design, monitor and evaluate progress towards restorative, sustainable cities? The 2030 Agenda encourages each country to find the best suiting strategy to implement SDGs effectively, tailoring it to its context. Promoting a policy integration, where each goal and/or target connects and impacts several others, the ultimate aim is that SDGs permeate national institutions and that indicators monitor and evaluate progress. Policy-wise this translates in support of multilevel and intersectoral policies. The main research question is: acknowledging the impact of urban agglomerations in health, mental health and in well-being; given the Portuguese context, which indicators can better account for progress concerning the interaction of both realms?

Methodology I adopt Monkelbaan’s (2019, p. 14) understanding of governance: “a collective enterprise aimed at solving problems, making decisions and creating opportunities; it can involve institutional, procedural, instrumental and organisational aspects; it is contextual and dynamic as its meaning changes from one policy setting to the other; and it is often closely linked with politics and government, but non-public sectors are increasingly involved”. This research aims to respond to the growing need for an articulation of European policies and national policies. This requires effective implementation of intersectoral strategies that promote cohesion national

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policies at interministerial and interregional levels. The assumption is that only a robust national cohesion policy will allow for a successful European Union cohesion policy. Considering this, I claim that intersectoral policies are essential to support EU’s cohesion policy vision, i.e. “overall harmonious development of its Member States and regions”. First, I make a detailed examination of each sectoral approach in health and spatial and urban planning, addressing the EU level primarily and second the national, Portuguese, level. Subsequently, I make a multilevel analysis articulating the impact of EU’s approach on national policies. This was a demanding task, and though not fully comprehensive, it is hopefully “robust enough” to provide state of the art in both sectors, policy-wise, at EU and national levels. This aims to facilitate an acknowledgement and a vision of how these can converge and be addressed by joint public policies. Then, I identify the 2030 Agenda as a nonbinding agenda-setting document which, due to its particular characteristics, is an excellent opportunity to take a renewed approach to current governance systems making them more resilient to VUCA scenarios—for example, the ongoing COVID-19 pandemic. What is the 2030 Agenda’s strategy; how do strategic goals translate into objectives and then into indicators? How can these indicators be integrated within the existing national sectoral framework? Finally, I argue that the chance of creating indicators at the national level is context-specific, as suggested by the 2030 Agenda, and the ability to develop mechanisms to monitor and evaluate progress should not be missed. The Agenda should be taken as a pretext to raise each country’s standards to become the best possible version of itself. Ultimately, the success of a given strategy or public policy is evaluated through indicators. These are vital to defining a tangible element that allows for measurement and quantification of objectives and goals in order to assess its implementation and impact. After conducting an organisational analysis, I suggest how can indicators be designed to evaluate a successful joint implementation of health and spatial and urban planning policies. This is when the strategic level translates into the operational level, when the EU’s strategy becomes national public policy and when the strategic vision of the 2030 Agenda is integrated and absorbed at the national level. To work in a cohesive and balanced way, governance, administration and management challenges need to be diagnosed so that indicators are relevant and successfully measured, implemented and monitored.

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References 2030 Agenda. (2015). A/RES/70/1 - Transforming our world: the 2030 Agenda for Sustainable Development. United Nations. https://sdgs.un.org/2030ag enda Berry, H. L., Bowen, K., & Kjellstrom, T. (2010). Climate change and mental health: A causal pathways framework. International Journal of Public Health, 55, 123–132. https://doi.org/10.1007/s00038-009-0112-0 Bourque, F., & Willox, A. (2014). Climate change: The next challenge for public mental health? International Review of Psychiatry, 26, 415–422. https://doi. org/10.3109/09540261.2014.925851 Côté-Roy, L., & Moser, S. (2018). ‘Does Africa not deserve shiny new cities?’ The power of seductive rhetoric around new cities in Africa. Urban Studies, 56(12), 2391–2407. https://doi.org/10.1177/0042098018793032 EC-EGD. European Commission-European Green Deal. (2021). Strategy, priorities 2019–2024, A European Green Deal. https://ec.europa.eu/info/str ategy/priorities-2019-2024/european-green-deal_en Giang, D. T. H., & Pheng, L. S. (2011). Role of construction in economic development: Review of key concepts in the past 40 years. Habitat International, 35(1), 118–125. https://doi.org/10.1016/j.habitatint.2010.06.003 Guizhen, H., Mol, A. P. J., & Lu, Y. (2016). Wasted cities in urbanising China. Environmental Development, 18, 2–13. https://doi.org/10.1016/j.envdev. 2015.12.003 Hanakata, N. C., & Gasco, A. (2018). The Grand Projet politics of an urban age: Urban megaprojects in Asia and Europe. Palgrave Commun, 4, 86. https:// doi.org/10.1057/s41599-018-0141-5 He, G., Mol, A. P. J., & Lu, Y. (2016). Wasted cities in urbanising China. Environmental Development, 18, 2–13. https://doi.org/10.1016/j.envdev.2015. 12.003 Lewis, T. M. (2009). Quantifying the GDP-construction relationship. In L. Ruddock (Ed.), Economics for the Modern Built Environment (pp. 34–59). Taylor & Francis. Monkelbaan, J. (2019). Governance for the sustainable development goals exploring an integrative framework of theories, tools, and competencies. Springer Nature. Marcantonio, R., Javeline, D., Field, S., & Fuentes, A. (2021). Global distribution and coincidence of pollution, climate impacts, and health risk in the Anthropocene. PLoS ONE, 16(7), e0254060.https://doi.org/10.1371/jou rnal.pone.0254060 Moser, S. & Côté-Roy, L. (2020). New cities: Power, profit, and prestige. Geography Compass, 15, e12549.https://doi.org/10.1111/gec3.12549 Moser, S., Côté-Roy, L., & Korah, P. I. (2020). The uncharted foreign actors, investments, and urban models in African new city building. Urban Geography. https://doi.org/10.1080/02723638.2021.1916698

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OGC. Oslo Governance Centre (2021). Sustainable Development Goals. Goal 11. https://www1.undp.org/content/oslo-governance-centre/en/home/ sustainable-development-goals/goal-11-sustainable-cities-and-communities. html Roe, J., & McCay, L. (2021). Restorative cities: Urban design for mental health and wellbeing. Bloomsbury Publishing. Reboredo, R. (2021). Disaggregating development: A critical analysis of Sino-African megaprojects. Progress in Development Studies, 21(1), 86–104. https://doi.org/10.1177/14649934211007639 Shepard, W. (2017, December 12). Why hundreds of completely new cities are being built around the world. Forbes. https://www.forbes.com/sites/wadesh epard/2017/12/12/why-hundreds-of-completely-new-cities-are-being-builtaround-the-world/?sh=3f721e1514bf United Nations. (2018). World urbanization prospects: The 2018 revision, highlights (ST/ESA/SER.A/421). Department of Economic and Social Affairs, Population Division. https://population.un.org/wup/Publications/ Files/WUP2018-Highlights.pdf Wei, T., Wu, J., & Chen, S. (2021, 12 July). Keeping track of greenhouse gas emission reduction progress and targets in 167 cities worldwide. Frontiers in Sustainable Cities. https://doi.org/10.3389/frsc.2021.696381 Wang, X.-R., Chi-Man Hui, E., Choguill, C., & Jia, S.-H. (2015). The new urbanisation policy in China: Which way forward? Habitat International, 47 , 279–284. https://doi.org/10.1016/j.habitatint.2015.02.001 Williams, S., Xu, W., Tan, S. B., Foster, M. J., & Chen, C. (2019). Ghost cities of China: Identifying urban vacancy through social media data. Cities, 94, 275–285. https://doi.org/10.1016/j.cities.2019.05.006 Willox, A. C., Harper, S. L., Edge, V. L., Landman, K., Houle, K., & Ford, J. D. (2013). The land enriches the soul: On climatic and environmental change, affect, and emotional health and well-being in Rigolet, Nunatsiavut, Canada. Emotion, Space and Society, 6, 14–24. https://doi.org/10.1016/J.EMOSPA. 2011.08.005 Willox, A. C., Stephenson, E., Allen, J., Bourque, F., Drossos, A., Elgarøy, S., Kral, M. J., Mauro, I., Moses, J., Pearce, T., & MacDonald, J. P. (2015). Examining relationships between climate change and mental health in the Circumpolar North. Regional Environmental Change, 15, 169–182.https:// doi.org/10.1007/s10113-014-0630-z Wilson, R. (2006). Policy analysis as policy advice. In M. Moran, M. Rein, & R. E. Gooding (Eds.), The Oxford Handbook of Public Policy (pp. 152–168). Oxford University Press. Yu, H. (2014). China’s “Ghost cities.” East Asian Policy, 6(2), 33–43. https:// doi.org/10.1142/S1793930514000142

PART I

Multilevel and Sectoral Policies

CHAPTER 2

Introduction. How Multilevel Governance Affects Spatial Planning and Health

The 2030 Agenda. Distinction Between Binding and Nonbinding Legal Instruments The 2030 Agenda (2015) is a nonbinding legal instrument. Alternatively, there are binding legal instruments. To identify the distinction between binding and nonbinding instruments, along with their potential advantages and disadvantages, I will use as primary reference Friedrich (2013), who presents a compelling case for the effectiveness of nonbinding instruments, particularly in international cooperation scenarios. Binding instruments establish a set of norms that are required and obligatory to those who agree to it. If they are not followed, specific legal penalties, previewed in a given document, will be applied. In that sense, the set of principles agreed upon are in fact, rules that all parties involved must submit to, “or else”. An example of an international binding law document is a treaty of law. Nonbinding instruments1 have a “voluntary” nature and are also legal documents, where all parties agree on a set of norms. The main difference is that these cannot be enforced, and if they are not fulfilled, there are no specific legal penalties. In that sense, the set of norms are, in fact, 1 Nonbinding instruments are also known as “soft law” instruments. On why this expression contributes to diminishing the legitimacy of these instruments, see Friedrich 2013, p. 13.

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principles that all parties agree that should be complied with. It is essential to highlight that they do not give rise to legal obligations, irrespective of politically binding. Examples of nonbinding instruments include resolutions, declarations, codes of conduct, guidelines and action plans (like the 2030 Agenda). These are used today to define concrete measures and best practices by states and private actors. One might wonder what is the practical use of nonbinding instruments if there are no penalties associated? Why would parties comply with what is agreed upon if there are no “real” consequences? Does this question the legitimacy of nonbinding instruments?

From Principles to Laws: Compliance, Implementation and Effectiveness The perceived legitimacy of nonbinding instruments refers to the justification of the exercise of authority. In these instruments, legitimacy comes from an internal sense of obligation to obey the rule based upon the normative belief by an actor that rule or institution ought to be observed. This is called the “compliance pull”. In that sense, legitimacy assessment lies in the ability of a given document to identify the challenges that consider the foundations of the system of legislation, i.e. its principles (Friedrich, 2013, pp. 375–377). Legitimacy in nonbinding instruments is essential, first to enhance compliance, second because sometimes they complement binding documents. Though they do not have specific penalties associated, they can add references to other documents that do. They can also prescribe norms that guide and constrain states and private actors to generate a first consensus. This can be particularly relevant in matters where agreements are complex, and conflict among parties is anticipated. A distinction should be kept between compliance, implementation and effectiveness, which is particularly relevant in nonbinding instruments (Friedrich, 2013, p. 128). Compliance has a broader scope than implementation and refers to the matching of the international norm and actual behaviour of actors. It is helpful to assess whether an actor follows a nonbinding norm. Implementation is used to describe measures taken to adapt domestic legal systems through legislation, judicial decision, executive decree or administrative processes to international norms. This means that principles are being transformed into laws at the national level, becoming, therefore, binding. Thus, compliance includes implementation, and implementation depends on whether a government ultimately

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implements its acts. Finally, compliance is not identical with the instrument’s effectiveness because the international instrument may not be effective in resolving or at least addressing the problems it was meant to address because of the inadequateness of its approach or its prescriptions (Friedrich, 2013, pp. 13, 14, 40–42). Mechanisms designed to enhance compliance with nonbinding instruments include reporting mechanisms, capacity building and other forms of subtle pressure and persuasion (Friedrich, 2013, p. 3). What happens if a norm agreed upon in a nonbinding instrument is not complied with? Norms prescribe certain appropriate behaviour, i.e. they are provisions of a deontic nature that contain a request or a recommendation. Treaty norms (legally binding) establish a binary code of legal/illegal. Similarly, nonbinding instruments establish a binary code of right/wrong by which future behaviour can be judged. In both cases, there is a dishonour of expectations affecting the standing of a state among the members of the particular organisation or, more generally, in the international community. Even though violations can carry less severe reputational costs, some nevertheless occur (Friedrich, 2013, p. 254). Nonbinding instruments often entail and emphasise procedural rather than substantive standards. Procedural rules prescribe how states or nonstate actors should conduct, and substantive rules of behaviour prescribe the end of certain damaging behaviour. Increasingly, nonbinding instruments stipulate concrete results, and one can find prescriptions of conduct or actions, i.e. norms that recommend a particular action. Before, the means of achieving the envisaged objectives and results are left to the addressees, i.e. to states and private actors (Friedrich, 2013, pp. 132,133). These instruments also tend to promulgate comparatively new and innovative norms in areas where binding rules are inexistent or insufficiently developed. “Their underlying purpose is mostly to promote change rather than preserve the status quo. Innovative approaches are often first adopted through nonbinding norms, in particular when compared with existing legal instruments” (Friedrich, 2013, pp. 601, 602). The nonbinding nature often facilitates agreement on progressive norms (Friedrich, 2013, p. 134). This is one of the advantages of nonbinding instruments. They can be precursors to customary or treaty law; they can promote interinstitutional cooperation and cross-sectoral norm-setting by helping to establish crosscutting standards that recognise instruments of other institutions and they

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are instrumental in influencing norm development and implementation activities of other institutions and thereby in integrating the views and norms of various institutions (Friedrich, 2013, pp. 214–218). Another advantage is that nonbinding instruments are not only addressed to states but also establish norms directed at private actors and other non-state actors. They facilitate the influence of non-state actors such as international organisations, expert groups and secretariats. They are particularly conducive to the inclusion of private actors such as nongovernmental organisations (NGOs). They can also be directed at organs or staff of institutions (Friedrich, 2013, pp. 136–138). Adaptability is also an advantage. Changes and revisions of nonbinding instruments can be easily achieved through a decision of the politicalinstitutional body or by participating governments. To assess the effectiveness of an instrument is the existence and design of follow-up and compliance mechanisms. In practice, mechanisms for compliance in the case of nonbinding instruments can include economic incentives, just like in binding instruments; reporting mechanisms to enhance transparency and institutionalise repeated discourse at the international and national level; and compliance assistance to address the capacity problems bringing states’ law and policy into compliance with the recommended norms. The specific potential of nonbinding instruments develops through the increasing institutionalisation and may shape state behaviour in the long term (Friedrich, 2013, pp. 287, 288). The analysis of the implementation of nonbinding instruments in national legal systems will show that they are to a considerable extent implemented into national law or influence administrative decisionmaking despite or even because of their nonbinding character. In the absence of specific legislative acts, they may become influential domestically even if not associated with a binding instrument avoiding parliamentary approval. These instruments entail the possibility of a shift of decision-making power to the executive not only on the international but also on the national level (Friedrich, 2013, pp. 324, 325). Among disadvantages of international nonbinding instruments are the fact that the non-compliance is not a violation of international law and therefore does not lead to state responsibility and therefore, dispute settlement cannot be applied directly, nor can states be held liable for damages and; there is no legal basis for on-site verifications and inspections without the consent of a state (Friedrich, 2013, p. 336).

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Overall, it is not the case that nonbinding instruments should always be used, but it is also not the case that binding instruments are always the best option. It is not a case of which instrument is better or worse. It is a matter of acknowledging that both legal instruments exist and can either be used jointly or independently, according to the context and goals at stake. The role of nonbinding instruments is relevant both in political and legal spheres. This clarification between binding and nonbinding legal instruments is helpful to clarify expectations when it comes to the 2030 Agenda. From the beginning, due to its nonbinding legal nature, it does not carry the expectation of solving all problems it accounts for simply because it was launched. The 2030 Agenda results from a long negotiation process (over two years, Kanie et al., 2017, p. 3) and, once agreed upon, is the beginning of an even longer process in the sense that it aims at implementation and effectiveness at the national level. It is also clear that as far as a nonbinding document can go, the 2030 Agenda pushes its legal framework to the limits. Goal setting articulates a set of shared aspirations hoping to generate enthusiasm among supporters and maximising the dedication needed to sustain the effort required to reach more or less well-defined targets. Goals usually specify a time frame in which they such be attained. Inversely, rules formulate behavioural prescriptions and direct attention to matters of compliance and/or enforcement. They are expected to remain in place indefinitely, having no assigned time frame (Young, 2017, p. 34). The 2030 Agenda embodies a shared sense that particular behaviours should be implemented to achieve featured goals and targets (procedural rules). Though rarely designed in nonbinding instruments (Friedrich, 2013, p. 343), the 2030 Agenda established an evaluation of individual state performance to attest compliance, using a set of indicators associated with each target, going beyond goal setting. Furthermore, going one step further, beyond compliance, and to assure implementation, the Agenda states that these indicators “will be complemented by indicators at the regional and national levels which will be developed by Member States, in addition to the outcomes of work undertaken for the development of the baselines for those targets where national and global baseline data does not yet exist” (2030 Agenda, 2015, p. 32). This is of the utmost importance. Each country can and is encouraged to design its own set of indicators according to its own needs, assuring that the path towards each goal is adequate to its needs, resources and priorities. This mechanism

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intends to bring the necessary flexibility that guarantees effectiveness, taking a realistic and adaptive straightforward approach to follow-up and compliance mechanisms. This mechanism will be particularly relevant in Chapter 4 of this book.

Nonbinding Instruments: Opportunities and Challenges for Health and Urban-Related Policies The 2030 Agenda’s ultimate ambition is that goals and targets operate a transformation at the institutional, national level to generate a systemlevel renovation. Taking a policy integration approach (see Chapter 7) where each goal is connected to several others, the renovation of the system at stake stems from acknowledging the need to create a new governance system that facilitates much-needed multilevel and intersectoral policies. The most immediate consequence is that the current understanding of what a specialist is needs to be challenged to carry this transformation forward. As Epstein (2019) eloquently articulates, decades of prejudice led us to believe that anyone who wants to develop a skill, or lead their field should start early, focus intensely and deliberately practise as many hours as possible. However, we now know this is not so. In most fields, especially those that are complex and unpredictable, generalists, not specialists, are primed to excel. What is a generalist? A generalist is someone who juggles many interests rather than focusing on one. Though generalists find success later in life, they account for professional athletes and Nobel laureates, being more creative and more agile. Generalists are also able to make connections that their more specialised peers cannot see. Taking Epstein’s research and going one step further, I suggest that we recognise something very significant if we apply this renewed understanding of knowledge to governance systems. The design of traditional sectoral policies and governance approaches always was knowledge-based. So is the case with the design of multilevel and intersectoral policies. The main difference is that whereas before the knowledge that supported the design of traditional sectoral policies and governance approaches was specialised (in health, education,

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urban matters, etc.), nowadays, the sense in which “specialised knowledge” is used needs to be different. Currently, a specialist is someone, for example, who masters a particular aspect of health, education and urban matters and understands how they connect. It’s not that they know everything about everything or that their understanding of reality is nonsystematic or unscientific; they know about a particular interaction that includes specific aspects of different sectors. In other words, specialisation nowadays is interdisciplinary. Being knowledge-based, governance systems are being called upon to reflect this change. To do this, it is necessary to look for alternative governance systems to adapt. Because the shift at stake will take time and has a scale that is still hard to apprehend at this point, we can say that just like knowledge is becoming increasingly specialised (in the most recent sense), public policies need to become increasingly intersectoral. The reasons that motivated an increase in the pursuit and valorisation of interdisciplinary knowledge are the same that should inspire the design of intersectoral policies: the increasing complexity and unpredictability of our surrounding environment that requires tailor-made solutions and the colossal scale of available information, i.e. the massive accumulation of scientific knowledge in each discipline that often makes it hard for scientists to be able to engage in a productive dialogue with other disciplines. This accounts for the intersectoral element. But why do policies need to address the multilevel aspect? Chapters 3 and 4 on health and spatial and urban planning clarify that national policies across sectors increasingly depend on and relate with transnational institutions adding upper levels of decision-making. Also, bottom-up approaches and local empowerment progressively claim their role in policymaking, adding more levels. One of the requirements of any public policy nowadays needs to incorporate all these levels and create a dynamic that allows for a successful flow. To start with, interdisciplinary knowledge should be called for, having a role in elaborating public policies taking the shape of informal cooperation or nonbinding instruments. These can be a way to foster interaction between spatial and urban policies and health policies at the national level, confirming the tendencies that it is possible to assess at the EU level. As will be demonstrated in the following chapters, intersectoral and multilevel aspects are much more accounted for in the realm of spatial and urban planning than in the health realm. Though I speculate why this is

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so further ahead, at this point, it suffices to say that whichever way we start, as long as we go forward, that is what matters.

References 2030 Agenda. (2015). A/RES/70/1 - Transforming our world: The 2030 Agenda for Sustainable Development. United Nations. https://sdgs.un.org/2030ag enda Epstein, D. (2019). Range: Why generalists triumph in a specialized world. Riverhead Books. Friedrich, J. (2013). International environmental ‘‘soft law”: The functions and limits of nonbinding instruments in international environmental governance and law. Springer. Kanie, N., Bernstein, S., Biermann, F., & Haas, P. M. (2017). Introduction: Global governance through goal setting. In N. Kanie & F. Biermann (Eds.), Governing through goals: Sustainable development Goals as governance innovation (pp. 1–27). MIT Press. Young, O. R. (2017). Conceptualisation: Goal setting as a strategy for earth system governance. In N. Kanie & F. Biermann (Eds.), Governing through goals: Sustainable development goals as governance innovation (pp. 31–51). MIT Press.

CHAPTER 3

Health

Health EU DG SANTE and the European Semester To assess the health sector in the context of the EU, I investigate orientations issued by the European Commission both in the context of the Directorate-General—Sante (DG Sante)—which has replaced DG SANCO, Directorate-General for Health and Consumers (1999–2014; Clemens et al., 2017)—and of the European Semester (ES) (created in 2010). As of 2019, the European Commission has 53 departments/executive agencies. This section focuses first on the Directorate-General—Sante (DG Sante), dedicated to “Health and Food Safety”. This Commission department aims at making “Europe a healthier, safer place, where citizens can be confident that their interests are protected” (EC-DG Sante, 2019). It develops and carries out the Commission’s policies on food safety and public health.1 DG Sante has four main goals: to protect and improve public health; to ensure Europe’s food is safe and wholesome; to 1 DG Sante is responsible for managing three independent Scientific Committees which provide advice to the European Commission: The Scientific Committee on Consumer Safety (SCCS); The Scientific Committee on Health and Environmental Risks (SCHER); and The Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR).

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protect the health and welfare of farm animals; and to protect the health of crops and forests. Due to the scope of the current book, the most relevant is the first goal. What does it encompass? “To protect and improve public health” encompasses: EU action on health; improving health systems; promoting good health; pharmaceuticals and substances of human origin; diseases and health threats; risk assessment; endocrine disruptors; and biocides (EC Public Health, 2019a). In some of these areas of action, we find specific items that are impacted by spatial and urban planning, particularly nutrition and physical activity, crisis preparedness and response, communicable diseases (treatment and prevention) and non-communicable diseases. Under non-communicable diseases (NCDs), we find cardiovascular diseases, cancer, chronic respiratory diseases and diabetes that represent significant causes of disability, ill health, health-related retirement and premature death in the EU, resulting in considerable social and economic costs. NCDs are the main focus of this book. The European Commission acknowledges that the Organisation for Economic Co-operation and Development (OECD) estimates that 550,000 people of working age die prematurely from non-communicable diseases every year in the EU. NCDs are known to be the leading cause of mortality in the EU, amounting to most health care expenses, costing EU economies e115 billion, or 0.8% of GDP annually (EC Public Health, 2019b). More significantly, in 2018, the report Health at a Glance: Europe 2018 (OECD/ EU, 2018), a general health EU document, made a strong case for promoting mental health and preventing mental illness. In reality, it is estimated that total costs of mental health problems amount to more than 4% of GDP across EU countries, equivalent to over EUR 600 billion per year—which includes the costs to health systems and social security programmes and lower employment and worker productivity. It called for more effective and people-centred health systems, better access to health care and more resilient health systems. This state of affairs has motivated the European Commission to develop a strategy based on a European integrated response “focusing on prevention across sectors and policy fields, combined with efforts to strengthen health systems” (EC Public Health, 2019b, my italics). To achieve this, the European Commission used as reference the nine voluntary global targets for “Non-communicable diseases and mental health” defined by the World Health Organization (WHO, 2011), to

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be reached by 2025, and the United Nations’ 2030 Sustainable Development Goals Agenda, in particular target 3.4, which aims to reduce premature mortality from non-communicable diseases by one-third, and promote mental health and well-being by 2030. To support countries in reaching the international targets, the Commission has set up a Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases (the Steering Group on Promotion and Prevention, or SGPP). The first set-up meeting took place on 30 November 2016. On 17 July 2018, the SGPP was established by the European Commission as a formal expert body (Decision C (2018) 4492 final), and the first formal meeting took place on 6 November 2018 in Luxembourg. The group replaces existing Commission expert groups (such as the EC Expert Group on Rare Diseases, dissolved in 2016) for particular diseases but may set up sub-groups for limited periods. The European Commission states that “the Steering Group will advise the Commission on selecting best practices and using them to support their transfer and scaling up at the national and European level using the funds from the EU Health Programme or other EU financial instruments” (Commission Decision, 2018). The Commission chairs the Steering Group, and the members are representatives of the Member States. The Decision shall apply until 31 December 2023. SGPP addresses policy implementation in mental health, rare diseases, cancer, nutrition and physical activity. It aims to develop further work previously conducted in these areas in an articulated manner (EC SGPP, 2019). EU Health Programmes (2003–2020) and the EU4Health (2021–2027) Turning Point Since 2003, four public health programmes (PHP) have been released: 1st PHP (2003–2007); 2nd PHP (2008–2013); 3rd PHP (2014–2020); 4th PHP-EU4Health (2021–2027). The first EU Health Programme was adopted in 2002 (Decision No 1786/2002/EC; CD 2002), and the Decision presents a summary of previous action plans concerning Europe’s public health. The first intent of taking joint action in public health dates from 1993, and since then, eight Decisions were taken to pursue this goal. The Health Programme was designed to develop a public health strategy aimed at “health promotion and disease prevention underpinned by intersectoral policy” (§7, my

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italics). This would allow both developing the appropriate knowledge base and establishing an efficacious health monitoring system. The overall aim of the public health programme is to contribute towards the attainment of a high level of physical and mental health and wellbeing and greater equality in health matters throughout the Community by directing action towards improving public health, preventing human diseases and disorders, and obviating sources of danger to health to combat morbidity and premature mortality while taking gender and age into consideration. To fulfil this aim, actions should be guided by the need to increase life expectancy without disability or sickness, promote quality of life and minimise the economic and social consequences of ill health, thus reducing health inequalities while considering the regional approach to health issues. Priority should be given to health-promoting actions that address the major burdens of disease. The programme should support the development of an integrated inter-sectoral health strategy to ensure that Community policies and actions contribute to protecting and promoting health. (§18, my italics)

Three goals are key in this declaration. The first is that health is referred to in its widest scope, incorporating mental health and wellbeing. Secondly, the reference to the priority to major burdens of disease should be clarified with a previous assertion that calls for an important task of the programme, which is “to identify better the main burdens of disease in the Community and, in particular, the main health determinants” (§10). Thirdly, the call for an integrated intersectoral strategy. Each of these goals is an indispensable element of the conceptual framework of this book. In 2004 the “Executive Agency for the Public Health Programme” was created for the management of Community action in the field of public health. (Commission Decision, 2004/858/EC; CD 2004). In 2008 a report on the implementation of the Public Health Programme in 2007 was issued. An ex-post evaluation was released in 2011 stating that the five highest-ranked recommendations called for a lower number of priority areas per year (not more than fifteen); also, for the establishment of clear performance indicators; the need to access to projects’ details; experts should define that priority areas; and inclusion of all Member States should be encouraged (DG SANCO, 2011, pp. 1–3). The 2nd EU Health Programme 2008–2013 (Commission Decision 1350/2007/EC; CD 2007) identifies several priority areas, among

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them the need to tackle health threats and encourage cooperation across borders between laboratories (§5), children and young people (§11) and to promote a holistic approach to public health using alternative medicine when needed (§24). The Decision quotes the WHO’s 2005 European Health Report, which establishes that the most important causes of the burden of disease in the European Region are non-communicable diseases (NCDs—77% of the total), followed by external causes of injury and poisoning (14%) and communicable diseases (9%). (§6) The ex-post evaluation (DG SANTE, 2015) reports that there seems to be confusion concerning DG Sante’s and Chafee’s role due to poor communication and that there is an excessive administrative burden of financial and contract management and of the application process (p. 4). Also, that most beneficiaries leading projects were from the EU-15. Three elements are relevant: (1) Senior-level DG Sante officials will get involved in designing annual planning so that implementation is more articulated with other policies and more effective (the first was issued in 2014); (2) There is a lack of instruments and methods that allow monitoring; and (3) Dissemination of results is low—which relates with an effort towards better communication at all levels which is mentioned throughout the document (4, 11–12). WHO (2013) adopts its comprehensive mental health action plan 2013–2020, setting out four global targets to be achieved by 2020: Global target 1: 80% of countries will have developed or updated their policies/plans for mental health in line with international and regional human rights instruments and 50% of countries will have developed or updated their laws for mental health in line with international and regional human rights instruments; Global target 2: Service coverage for severe mental disorders will have increased by 20%; Global target 3: 80% of countries will have at least two functioning national, multisectoral promotion and prevention programmes in mental health and the rate of suicide in countries will be reduced by 10%; Global target 4: 80% of countries will be routinely collecting and reporting at least a core set of mental health indicators every two years through their national health and social information systems. The ambitious goals set by WHO positively impact the EU, which takes a renewed approach and a step forward in mental health. In 2014 the 3rd Public Health Programme (PHP) was launched, EU Health Programme 2014–2020 (Regulation (EU) No 282/2014; Regulation, 2014). This programme followed the strategy defined by Europe

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2020, encouraging a smart, sustainable and inclusive economy promoting growth for all. The goal was to support Member States in public health by facilitating collaboration through annual work programmes agreed upon among countries. The Consumers Health Agriculture and Food Executive Agency (Chafee) is a supporting institution, organising calls for proposals for projects and operating grants and calls for joint action and tenders (EC Public Health, 2019c). Within the legal realm, there is a difference concerning this programme. The first two PHP were Decisions, and this one is a Regulation. Decisions are laws directed to specific members, private individuals or companies and are binding upon those they are directed to. A Regulation has an unequivocal binding legal force throughout every Member State and enters into force on a set date in all the Member States. The fact that the 3rd Health Programme is issued through a Regulation reinforces the intent of designing a harmonising health policy across EU Member States. One relevant aspect is that while the 2nd Health Programme made no specific reference to mental health, the 3rd Health Programme dedicates §3 exclusively to mental health, stating along with WHO an all-encompassing sense of “health” (physical, mental and well-being). Is it acknowledged that mental health problems account for almost 40% of years lived with disability and that economic crises have a negative impact. Relevant new aspects of the dynamics of the programme structure-wise are: a clear statement that establishes that implementation is the responsibility of each Member State; and that in the application of the Regulation, the Commission should consult the relevant experts, including National Focal Points—those bridge national authorities of Member States and the EC. Content-wise is it claimed that patients should be empowered to make informed choices; involvement of NGOs should be encouraged; and there needs to be better monitoring. The 2017 mid-evaluation indicates that the programme is running on the right track and calls for cooperation with other EU financial instruments (EC, 2017). An external mid-term evaluation of the programme (DG SANTE, 2017) states that the programme is a major improvement and that “the consultation of Programme committee members and national focal points representing Member States’ interests confirmed that the 3HP structure matches the main health challenges in their country. A perception of the appropriateness of the 3HP design and structure was also confirmed in replies to the open public consultation” (p. 4). When it comes to recommendations concerning the thematic focus of the programme, thematic priorities

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should be more clearly defined, and links should be built between the HP and the wider policy agenda to maximise impact (p. 10). Issues already addressed in previous programmes remain: low participation of poorer Member States, the need for better communication and more effective indicators (p. 11). The most recent 4th PHP-EU4Health 2021–2027 (Regulation (EU) 2021/522; Regulation, 2021) was drafted to respond to COVID-19. The main goal is to provide a sustained crisis response, addressing healthcare systems’ resilience. Accordingly, its four main goals are to improve and foster health in the Union; to tackle cross-border health threats; to improve medicinal products, medical devices and crisis-relevant products (making them available and affordable); and to strengthen health systems, their resilience and resource efficiency. Additionally, it identifies three urgent health priorities: response to the COVID-19 crisis and reinforcing the EU’s resilience for cross-border health threats; Europe’s Beating Cancer Plan; and the Pharmaceutical Strategy for Europe. The EU4Health 2021–2027 represents a turning point concerning the attention given to mental health, jointly addressed as part of “health” in a descriptive manner, for the first time among PHPs. The term “mental health” is addressed explicitly in general provisions. It affirms expressly that action should be promoted, directed to those suffering from non-communicable diseases, including mental health, to “prevent the collateral impact of health crises” (§4). Further ahead, it acknowledges that non-communicable diseases cause a considerable social and economic impact, highlighting the importance to prevent and improve mental health, explicitly refereeing Goal 3 (Health and Well-being) from the 2030 Agenda. It states that the programme should articulate its objectives with “The European Green Deal” (§21) and that “it is essential to provide an integrated response that focuses on health promotion and disease prevention across relevant sectors” (§20). In a section dedicated to definitions (Article 2), I consider particularly relevant the last three that claim the importance of promoting “health in all policies”, which means taking a new approach to “the development, implementation and review of public policies, regardless of the sector” (§10); broadening the concept of “health determinants” as all those that “influence the health status of a person, such as behaviour-related, biological, socio-economic and environmental factors” (§11); and finally,

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“emergency support” as a needs-based emergency that includes “preserving life, preventing and alleviating human suffering, and maintaining human dignity” (§12) (Regulation, 2021). Having provided a brief overview of DG Sante’s initiatives, the same will be done concerning another European Commission enterprise, the European Semester. European Semester Recommendations (2010–2019) The European Semester (ES), created in the aftermath of the global financial crisis of 2007–2008, is the most recent EU’s economic governance instrument aiming “to monitor, prevent, and correct problematic economic trends that could weaken national economies or negatively affect other EU countries” (EC, 2019). Along with the “Stability and Growth Pact” (SGP) specifically focused on promoting sound public finances and fiscal policy coordination, it is the leading EU Economic governance instrument for monitoring, prevention and correction. The ES has a broader and more encompassing scope aiming to strategically coordinate and articulate different areas to achieve a more comprehensive overview of the macroeconomic scenario of a country. It has an annual cycle known as macroeconomic imbalance procedure (MIP) starting in November with the European Commission’s alert mechanism report (AMR), which analyses the economies of all EU countries. An additional in-depth review (IDR) can be added, and the annual country report is issued in February. Countries that may find themselves experiencing some kind of macroeconomic imbalance may receive policy recommendations for reducing them in their country-specific recommendations (ES, 2019). The ES is a strategically significant instrument at the European level that aims to have a clear impact on each European country’s annual budget, influencing planned expenditure and revenue. The health sector is one of the most demanding items in a country’s budget regarding expenditure. In Portugal’s 2018 budget, 15.2% of the total budget (among 17 Ministries) was assigned to the Ministry of Health (first is the Ministry of Work, Solidarity and Social Security with 28.9%; and second the Ministry of Finances with 18.7%.) (DGO, 2019). Have the ES’s recommendations impacted the Portuguese health sector?

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The ES issues country-specific recommendations (CSRs) every year. Despite being created in 2010, and having issued its first set of country reports in 2012, only in 2015 has the ES issued a report about Portugal (EC, 2019b). Regarding the health sector, at a time when the country’s structural deficit was around 3.5% of GDP (EC-DGEFA, 2015, p. 12), the 2015 report states that there were challenges related to structuralfiscal policies in the fields of pensions and the health system due to ageism. The old-age dependency ratio is expected to increase from 29.4% in 2013 to 63.9% in 2060 (EU-28 in 2060: 50.2%). The impact on the health system is challenging: public health expenditure is projected to rise more than the EU average; in 2012, health expenditure accounted for 9.5% of Portugal’s GDP; the country has one of the lowest shares of public expenditure in total health spending (63%, compared with the EU average of 73%); out-of-pocket payments as a share of total health expenditure increased between 2007 and 2012 by 4.5 pp (the highest increase in the EU); and 14% has no family doctor. It is acknowledged that hospitalsector reforms and cost optimisation are taking place; however, the results are yet to come (pp. 35, 36). In 2015, one recommendation was issued concerning the healthcare sector: “Control healthcare expenditure growth and proceed with the hospital reform” (p. 49). In 2016, Portugal’s country report (EC Country Report, 2016) claimed that two contradictory goals needed harmonisation. On the one hand, the country aims at long-term fiscal sustainability in the healthcare sector; on the other hand, it wants to maintain the level of access to healthcare by improving efficiency in the system. The result is that it is expected that the increase of public healthcare expenditure as a proportion of GDP by 2060 comes to 2.5%, the highest in the EU (pp. 3, 44). The main factor contributing to this situation is ageism and the growing prevalence of chronic disease. Therefore, the EC considers that “it would be appropriate to adopt a long-term perspective when tackling the cost of ageing” (pp. 25). Accessibility persists as a problem, and uneven geographic distribution of doctors is identified as one of the leading contributing causes. Hospital reform is encouraged to proceed, together with the expansion of family health and community care units. The conclusion is that “care outcome indicators in Portugal are good overall, although spending on prevention is relatively low by European standards” (p. 44). The recommendation in 2016 concerning the health sector is related to arrears that, despite falling, continue to be a pressing issue due to underbudgeting by hospitals (p. 65).

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It is noticeable that Portugal’s country report in 2017 features more information, presenting a more in-depth perspective of the sector, being the diagnosis much more encompassing. However, it is harsher, stating that the country has overall “made limited progress on addressing the 2016 country-specific recommendations”. However, it is acknowledged that “some progress” occurred towards long-term sustainability of the healthcare sector and access to primary care (EC Country Report, 2017, pp. 1, 13). Portugal has made efforts to ensure access to quality healthcare (centralised Procurement of goods and services; use of generics; improving the IT system; and vaccination campaigns) (p. 23). These are likely to help cut costs in the long term. Nevertheless, in the short term, the biggest obstacle is the growing stock of arrears in hospitals and recent measures concerning public sector working hours (p. 2). Arrears in hospitals have been growing since the beginning of 2016, indicating a lack of control overspending, especially in the health sector (p. 24). The leading cause is a weak accounting and managerial control, which undermines the health sector’s viability (p. 23). Furthermore, “the lack of sound budget planning and implementation in hospitals […] is not enough to guarantee arrears clearance and spending control” (p. 11). The situation is worrisome because it is known that historically the health system has run losses and has been unable to clear its arrears (p. 17). Overall, the health of the Portuguese population is good, yet some indicators point to potential inequalities in access. Access to primary health care is limited, and in 2015, 10% of the population did not have a family doctor (p. 36). The uneven geographic distribution is again pointed out as a major contributing factor, but it is mentioned that policies are being put in place to overcome this. Another contributing factor to inequality is the gap between the poorest households and the richest in self-reported unmet medical examination needs that have increased to 6.7 PPS. in 2014 (EU average: 4.9), from just 2.3 in 2008 (p. 6). Other factors pointed as critical are, again, out-of-pocket expenditure that continues to be very high (p. 37). Also, “mortality due to respiratory diseases” and “healthy life years for females” rank among the worst in the EU. It is stated that Portuguese women live longer periods with disease or disability than the EU average, shortening their working lives. The reason for this to be so can be in part due to a shortage of health promotion and disease prevention activities that tend to address healthy lifestyles and disease screening. Relevant to the final recommendation is the admonition

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that “[i]n spite of short-term savings in the health care sector, Portugal lacks a comprehensive long-term strategy to addressing the health-related costs of ageing” (p. 24). The 2017 recommendation is: “Ensure the longterm sustainability of the health sector, without compromising access to primary healthcare” (p. 56). In 2018, the EC considered that Portugal has made “some progress” in addressing the 2017 country-specific recommendations, but arrears remain a crucial concern (EC Country Report, 2018, p. 1). The population’s health status is relatively good, but health inequalities remain (due to access and the aforementioned geographical gap) (pp. 8, 35). Ageing costs account for the largest share of healthcare expenditure (p. 22), from 5,9% of GDP in 2016 (below the EU average of 6,8%) to 8.3% in 2070, representing a 2.4 pp increase to the projected EU average increase of 0.9 pp. Again, the EC calls for “a comprehensive strategy to tackle the health-related costs of ageing, including chronic diseases”. Spending is also expected to increase due to the need for investment in equipment, given that a large part of it is out of date (p. 23). Concerning the labour market, it is known that overall outward migration has decreased. But concurrently, in the health sector, a significant number of professionals were recruited from EU and non-EU countries (e.g. 1 836 non-national doctors in Portugal in 2015) (p. 37). There are two main recommendations in the realm of health in 2018: (1) “Step up efforts to broaden the expenditure review to cover a significant share of general government spending across several policies” (where there has been “some progress”); (2) “Strengthen expenditure control, cost-effectiveness and adequate budgeting, in particular in the health sector with a focus on the reduction of arrears in hospitals” (“limited progress”) (pp. 57,58; 12, 14, 23). The following year, EC Country Report (2019) mainly insists on controlling expenditure due to ageism. Due to the pandemic outbreak, I will not refer to ES’s recommendation due to its exceptional nature. Concerning the EU’s health sector, it is possible to define three relevant periods. The creation of DG SANCO in 1999 is the first effort to create a joint European answer to public health; followed by the first, second and third PHP (2003–2007; 2008–2013; 2014–2020), which first made use of a legal instrument (a Decision); and, since 2014, in its 3rd PHP, became a binding legal force (Regulation) and lastly, the ES which also includes recommendations concerning health framed by a fully encompassing macroeconomic analysis. This confirms health as a growing

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area of concern within the EU and also an effort towards intersectoral policies that promote it. The following section will present a brief review of main legal instruments at the national level related to the health sector in Portugal.

Health PT To Compare Health Guidelines Before 2004 Between 1998 and 2002, Portugal was implementing the strategy “Health: A Commitment” (“Saúde: um compromisso”) to guide its health-related policies.2 In March 2002, an evaluation report was issued by Director-General and High Commissioner for Health, José Pereira Miguel, stating that due to political reasons, the strategy, at times, was not considered an adequate path but still, it reflected some consensus concerning its main goals (Ministério da Saúde, 2002, p. 13). Among the reasons for this report to be issued so close to the end of the strategy’s implementation, instead of after its ending, is the resignation of the Prime Minister in office António Guterres in December 2001 that claiming to prioritise the political stability of the country decided not to complete his second term (1999–2003). The report takes this political transition as an opportunity to present a state of the art of the health sector, clearly highlighting which areas should continue to be prioritised so that the future government could take it as a critical document.3 The 2002 report identifies four key areas: family, drugs and healthy living, specific diseases (among them mental health) and the surrounding environment. The report estimates that 30% of the Portuguese population suffers from a psychiatric disorder; however, it is stated that due to lack of data, no further description of the country’s mental health landscape is possible

2 The strategy was based on a report that presented the state of affairs published in 1997, titled “The Health of the Portuguese” (“A Saúde dos Portugueses ”). 3 António Guterres was the leader of the Socialist Party (PS) that was slowly losing general support. In March 2002, the Portuguese legislative elections elected José Manuel Barroso as prime minister (from the opposition party, Social Democrat Party (PSD)). The report’s timing indicates that it aimed to ensure that the health sector’s main priorities and associated public policies were not discontinued.

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(p. 132).4 Consequently, it is also acknowledged that there is a low intervention capacity, particularly in non-costal areas and that apart from hospitalisation, no real alternatives are available. It is highly relevant to the claim that up until 1998, there was a legislation gap concerning mental health service organisations and that compulsive hospitalisation prevailed over a community-based intervention. Several examples are given of legislation and cabinets recently created to address mental health, among them, since October 2000, within the framework of the Law for Mental Health (Law n.36/98, 24 July), the creation of the National Council for Mental Health. It is also announced that a National Plan for Mental Health was in the works (p. 134). Main recommendations for the future were the need for better service organisation (planning, management and evaluation) and, equally important, the confirmation that “[m]any of the answers portrayed go beyond the realm of mental health, being key an interinstitutional and intersectoral articulation, and a public–private articulation” (p. 136, my italics). The Law for Mental Health (Law n.36/98, 24 July) updated the previous Basic Law for Mental Health (n.2118/63, 3 April). The 1963 law was the First Mental Health Law in Portugal, and it envisioned a progressive decentralisation of mental health services. It decreed that Centres for Mental Health should be created in every region (including specialised services specifically addressing children and teenagers’ needs), connecting them with primary health care services. Between 1985 and 1989, the first programmes on how to reorganise mental health services are planned. This encompasses creating mental health centres in metropolitan areas and implementing a national information system for mental health. In 1992, there was a call for all mental health centres to be incorporated in general hospitals. However, due to a lack of technical and financial autonomy, this community approach to mental health services was suspended (Caldas de Almeida et al., 2015, p. 16). The 1998 law confirmed the community approach to mental health and legally called for an integration of Mental Health services within primary health care

4 Between 12 and 18 November 2001, the third National Psychiatric Census took

place (having the first two taken place in 1988 and 1996), including for the first time not only hospitalisation but also appointments, emergencies, private institutions, Portugal, Azores and Madeira. The Census includes data provided by 66 institutions (45 public; 18 religious orders; 3 private) (Bento et al., 2001). The few existing data relies on this Census.

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services. Specialised care units should be provided in general and community hospitals. The law also determined the design of programmes and structures that would encourage psychosocial rehabilitation, legislation to endorse employment and the creation of a National Plan for Mental Health. The above mentioned 2002 report on the initiative “Health: A Commitment” noted that the Plan was being drafted. It was issued in 2008 and titled National Plan for Mental Health (2007–2016). In January 2003, the Ministry of Health (2003) issued a working document presenting main strategic guidelines for the ongoing year. It is noticeable that an alignment with EU’s first PHP (2003–2007) is being aimed at (pp. 94, 95), and this is a more encompassing document than the previous 2002 report. Mental health is addressed under “health determinants”. An assessment of the situation stresses, first and foremost, that there is a lack of data concerning mental health and that no system is in place to change the situation; also, that there is a high prevalence of stress which impacts mental health; that inadequate care is available for children and adolescents; and also, inadequate care is available for the elderly. Measures are suggested (in very broad terms), taking these aspects as a priority. It is mentioned that a National Plan for Mental Health is being developed.5 This time around, there is no mention of interinstitutional and/or intersectoral policies. Significantly the document includes a chapter on environmental health, which includes a section on “housing and health”, suggesting two main interventions. One that calls for bio-architecture, that allows addressing quality and well-being within the housing context and a second one that calls for a more comprehensive assessment of housing impact on health, including not only infrastructures but also “common shared spaces, (condominium, staircases, elevators, garages, basements, attics, garbage dumps, etc.), nearby surroundings (gardens, parking lots, roads, children’s recreation spaces, etc.); quality of the indoor air; noise; infestations and plagues” (p. 27). This categorical connection between health, the surrounding environment and architecture is ahead of its time. A recommendation for an articulation between

5 In this 2003 report, Maria João Heitor (Directorate-General of Health, Ministry of Health) is appointed as being responsible for the following programmes or activities: Health contribution for the Action Plan to control excessive alcohol consumption; National Plan on Mental Health; National Plan of Continuous Care in Mental Health; Hospital Referral Network for Psychiatric and Mental health (pp. 108, 109).

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health, surrounding environment and architecture, will feature among main orientations in public health policies again in 2004. Changes and Priority Areas Introduced by the First National Health Plan (2004–2010) The first National Health Plan (2004–2010) was officially issued in July 2004, led by José Pereira Miguel, Director-General and High Commissioner for Health, under the guidance of Luís Filipe Pereira, Minister of Health.6 It features two documents, “priorities” and “strategic orientations” (Ministério da Saúde, 2004c, 2004d). An English version of “priorities” was available in July 2004 (Ministry of Health, 2004). The section dedicated to mental health care consists of a brief description of existing resources in 2003, which we now transcribe: 36 psychiatric and paedopsychiatric establishments and 3 alcohology regional centres, with an overall inpatient capacity of 2,640 beds (60.2% of the existing beds are concentrated in 5 psychiatric hospitals). As for human resources: 422 psychiatrists, 160 psychologists, 40 paedopsychiatrists, 124 social service professionals, 65 occupational therapists, 1,227 nurses, 5 psychomotricity professionals, 15 speech therapists, 9 pre-school teachers, 3 education professionals, 7 special needs teachers and 7 general practitioners. Included in the mental health care section is the description of units specialised in health care for drug addicts (Ministry of Health, 2004, p. 7). The Plan prioritises oncology diseases, circulatory diseases, communicable diseases, mental illness and trauma (motor accidents and workrelated) (p. 17). The two central organisational axes are citizen participation and innovation. The main tools for this to happen are a more business-like management, public–private partnerships, more top-down coordination, reinforcement of horizontal management (with schools, workplaces, vulnerable population, food safety, road safety) and revision of incentives (p. 27). Creating a health-conductive environment, where the quality of life is highlighted, is mentioned in very broad terms (pp. 21, 22). Analysing the more detailed document “strategic orientations”, we again find the item addressed as “housing and health”. Similarly, the 6 Two preliminary versions were issued in December 2003 and February 2004 (2004a; 2004b; Ministério da Saúde 2003).

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connection between the built environment and health takes place. However, it is stated that up until then, this connection has not been considered by any health-related institutions and therefore, due to lack of data, it is impossible to evaluate the impact of housing on health in Portugal. It stated that buildings can represent a health hazard but goes no further than this. A final paragraph about this item is added stating that many elderly live in degraded housing, which is one of the main reasons for their institutionalisation—though no data is presented, making the statement unfounded (Ministério da Saúde, 2004d, pp. 115, 116). It is acknowledged that there is no integrated vision of the health system, that it is necessary to invest in public–private partnerships, that primary health care is not available entirely to the population and that there are many deficiencies concerning hospitals networks. The need to reorganise the whole network is frequently claimed mainly because it is acknowledged that there are serious accessibility problems to health care services and miscommunication between services and citizens (pp. 151– 164). When it comes to mental health, the problems and solutions identified are the same as those presented in the January 2003 report. New elements are the strategy of opening new psychiatric departments within general hospitals, new key competencies for existing psychiatric hospitals, a revision of the Reference Network for Psychiatry and Mental Health, the creation of Regional Centers of Forensic Psychiatry, better articulation between psychiatry, prevention, hospitals and primary health care units. It is again mentioned that a National Plan for Mental Health is about to be issued (pp. 82–90). Though new initiatives are mapped out, a detailed description of how will these be implemented and articulated with existing resources is not provided. To clarify this, the “Action Plan for Health 2004 – Priority Areas” provides additional answers (Ministério da Saúde, 2004e). The section dedicated to mental health presents six indicators to monitor progress with targets to be achieved up until 2010 concerning depression and alcohol consumption. For example, it is a goal to reduce by 50% the suicide rate among those below 65 years old; also, to increase general practitioners’ ability to diagnose depression from 33 to 50% (p. 119). However, considering that a lack of data in the realm of mental health is often stated and that the most reliable source of information is the scarce information provided by the 2001 Census, on what grounds were

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these targets established as priorities and, consequently, how real can the expectations be that they will be accomplished? Concerning the National Health Plan (2004–2010), the Ministry of Health of Portugal requested the World Health Organization (WHO) to carry out an external evaluation of the Plan (WHO, 2010, p. ix). The assessment was published featuring policy recommendations and a summary of performance indicators. It is acknowledged that a significant effort was made, and the health sector is much better when compared to 25 years ago; however, a few significant comments are important findings: there are essential policy gaps; the Plan does not draw in-depth attention to the distribution of health across the Portuguese population; it does not address the financial sustainability of the Portuguese health system; it fails to address elements of inequality in health financing; it has a narrow strategic focus on sustainable human resources for health; it does not focus sufficiently on the quality and safety of health care services; the number of targets attached is too large to allow for a proper prioritisation (out of 64 performance indicators only 28 had been achieved or were likely to be achieved); the framework for the evaluation of the Plan was not preestablished (p. x). The intersectoral question is directly addressed and supported in WHO’s report: There was a general impression expressed by many interviewees from different sectors and levels of administration that the Portuguese politicaladministrative culture and traditions are not favourable to fostering intersectoral collaboration. Particularly at the central level, there seems to be a tendency to work in a fragmented way, which in itself is not conducive to intersectoral action in health. If this is the case, there are great challenges ahead in working towards a pan-governmental or collaborative governmental approach, and further steps will have to be taken to strengthen intersectoral action. (WHO, 2010, p. 19) Interministerial involvement and collaboration should be strengthened and capacities for health impact assessment developed across Government. (WHO, 2010, p. 26)

When it comes to governance, WHO recommends that instead of promoting the Plan through a centralised fragmented Ministry of Health, the Ministry of Health should refocus on its stewardship role and give

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Regional Health Authorities the responsibility for planning the implementation of the Plan. Furthermore, Regional Health Authorities should take the lead in planning and in engaging stakeholders and the community at the local level (WHO, 2010, pp. 26, 27). In summary, main recommendations are that a balance between broad goals providing direction for action and a limited number of quantifiable objectives for health system strengthening should be reached and, key policy gaps should be addressed in the next Plan, chiefly health system sustainability and health inequalities (WHO, 2010, p. 27). Specifically addressing mental health, in 2006, Portugal has contributed to a report published by the EU’s Health & Consumer Protection Directorate-General featuring a description of the state of the art of the mental health sector across Europe (Heitor dos Santos et al., 2006, pp. 129–133, see ANNEX). Portugal’s state of the art description is realistic and shows that much remains to be done. This reflects a positive attitude since only reality can be a healthy starting point to promote change, and it should be commended. Some fundamental statements include “[d]ue to national budget constraints, the funding has been mainly used for infrastructure development”; “although policy or practice guidelines on mental health promotion or mental disorder prevention have not been developed yet, they are now in preparation”; “[m]ental health does not seem to be a high priority in Portugal as evidenced by the number of references to it in speeches and policy documents by politicians and policymakers, but there is interest in it. Drug problems and AIDS have been the highest priorities in health”; “[a]lthough mental health is slowly becoming a priority as evidenced by the increased amount of resources put into the field more recently, there have been no or little changes in resources because of the non-existence of a budget allocated especially to mental health promotion or mental disorder prevention” (p. 131). The main challenges to the implementation of the National Health Plan (2004–2010) identified are the lack of funding, lack and/or heterogeneity in the distribution of human resources in mental health and a decrease of compliance (poor motivation, less availability of time, etc.) among health care professionals, particularly in primary care. It is stated that when it comes to monitoring and evaluation, no evaluation studies on the effectiveness or the cost-effectiveness of mental health promotion or mental disorder prevention programmes implemented in Portugal was carried through (p. 132).

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Following this report elaborated for the EU’s Health & Consumer Protection Directorate-General, during the implementation of the National Health Plan (2004–2010) the highly anticipated National Plan for Mental Health (2007–2016) (Plano Nacional de Saúde Mental 2007– 2016, 2008) was released. (The original and more detailed version is titled “Action Plan: Restructure and Development of Mental Health Services in Portugal”) (CNRSSM, 2007). These two documents are the first fully dedicated to a serious in-depth diagnosis and careful intervention strategy in the sector. They have provided main orientations guiding the mental health sector in Portugal since then and up until 2020. The Ongoing National Health Plan (2012–2016) and the First National Plan for Mental Health (2007–2016) Both Extended Up Until 2020 The National Plan for Mental Health (2007–2016) is a powerful guiding instrument.7 The National Commission to Restructure Mental Health Services, presided by José Miguel Caldas de Almeida, elaborated it. It provides a very lucid diagnosis of the mental health sector in Portugal, lays down specific goals and presents a well-defined strategy (mainly based on a reorganisation of the sector). Both documents are an invaluable achievement that should be highly acclaimed, whether in its short or long version. The Plan sets five main goals: equitable access; protect human rights of those experiencing mental health problems; reduce the impact of mental disorders; promote decentralisation of mental health institutions; promote the integration of mental health care within the general health system (Plano Nacional de Saúde Mental 2007–2016, 2008, p. 17). Among main strategic actions, the need for an intersectoral approach is called for claiming an articulation with existing organisations. However, the Ministry of Justice is the only Ministry mentioned, and the creation of a group Mental Health/Justice is suggested to address situations where a patient is non-imputable (p. 31). I highlight some relevant statements of the Plan, though the Plan is worth reading in its entirety, presenting a realistic and accurate perspective of the sector. 83% of the budget is spent on hospitalisation, and it is 7 The Resolution was approved by the Council of Ministers (RCM), n.49/2008, 24 January, which has also created a National Coordination for Mental Health within the framework of the High Commissioner for Health (Alto Comissariado da Saúde).

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known that both families and users prefer community intervention (p. 8). For this to happen, decentralisation is vital, and though this has already started to be put in place, there is a lot of uncovered territories (p. 6). Programmes focused on prevention are practically non-existent (p. 9). There is a lack of scientific research in psychiatry and mental health (p. 9). And lastly, the Plan calls for an independent budget dedicated to mental health (p. 32). Chapter 8 of the Plan is devoted to evaluation and quality strategy, and this will be addressed further ahead in Chapter 8 of this book. The extended version of the Plan (CNRSSM, 2007) features a section dedicated to each of Portugal’s five regions to clarify and detail as much as possible how can decentralisation can be carried through. This intention was already legally expressed in 1999 (Decreto-Lei nº 35/99) that has established local services for mental health (SLSM) and regional services for mental health (SRSM), anticipating what would become a trend in Europe. However, the governance model has become an impediment for this to work since the SLSM were given no autonomy being hierarchically dependent technical, administrative and financially from a Psychiatry Department based in a general hospital. The Commission considers that this aspect is central to improve mental healthcare provision. The suggestion is to create the conditions that allow that the 1999 law is applied to strengthen the network through local units, privileging a community-based approach (pp. 55, 58). In July 2017, the National Plan for Mental Health (2007–2016) was extended until 2020 (original version: 2017; summarised version: Programa Nacional para a Saúde Mental, 2017; CTARSM, 2017). The documents provided a careful evaluation of what has been achieved and also established new goals. Once again, the attention given to an evidence-based diagnosis is unmistakable. Based on goals identified as “low execution”, a new strategy was put in place to achieve them by 2020. Among the aforementioned goals are: the need for new financing strategies (Perelman et al., 2018); new governance and management models; increase available human resources; integration with primary health care units; and collaboration with the Ministry of Justice (26, original version). In 2013, a new general National Health Plan (2012–2016) was published (National Health Plan 2012–2016, 2013). Though there is hardly any mention of mental health, we can find in the document’s bibliography reference to the European Healthy Cities Network, WHO’s Healthy Cities Network and the Portuguese Healthy Cities Network. This

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suggests that there is some acknowledgement that urban and spatial planning is relevant to promote health. In 2015, the Plan was extended until 2020 (Plano Nacional de Saúde, 2015), mentioning the need for intersectoral collaboration and a healthy environment among its goals (pp. 20, 21). WHO proceeded to evaluate the Plan’s implementation in 2015, and it praises the reference to the Healthy Cities initiative (Portuguese National Health Plan, 2015, p. 3). The Joint Action on Mental Health and Well-being also provided an analysis of Portugal’s mental health policies and state of the art review offering a detailed analysis of obstacles that prevented a successful implementation of the National Plan for Mental Health (2007–2016) (Caldas de Almeida et al., 2015).8 In its 2018 report, WHO relates the onset of mental health diseases 10 to 15 years earlier in those living in deprived areas when compared to those living in affluent areas. Also, it states that mental illness needs better services and that despite hospitalisation numbers dropped, the prescription of anti-depressants is now the highest in the EU. Though unsubstantiated, a correlation between this fact and an increase of depressive disorders during economic crises is established.9

8 Among them: low technical and financial autonomy, particularly at a local level which

hinders the basic principle of proximity in community approaches; lack of coordination among mental health system’s actors, primary health services, community teams, hospitals and community services for rehabilitation; weak institutional governance structure which obstructs decision-making processes; lack of incentives to implement community interventions, to medical and non-medical professionals; lack of regional mechanisms (ARS/Regional Administration for Health) to monitor implementation of services and partnerships, based on quality standards. (Caldas de Almeida et al., 2015, p. 311). For a critical evaluation of Portugal’s health system since 1998, see Frias and Pinto da Costa 2020. On incentives, see Perelman et al., 2018. 9 It is essential to state that the account is unsubstantiated mainly because economic crises are known to have a negative impact on mental health, but considering this is a 2018 report and that the crisis hit in 2008, this calls for a discussion (that is long from settled): has the crisis ended or is it ongoing? If it has ended or, at least, slowed down, should we not expect that anti-depressants’ prescription should have also lowered? Curiously enough, the report uses the plural “economic crises”, indicating that the phenomenon is extended in nature, going far beyond 2008—whichever year is historically established as the crisis ending year. This statement is also relevant because it implies that no real alternative was put in place through hospitalisation has decreased. Medication has been the replacement strategy—which is highly undesirable and far from the community-based strategies that the National Plan for Mental Health (2007–2020) calls for. An account for the surrounding environment, wealth wise, is identified as a relevant factor that is strongly connected with mental health, which is an intersectoral correlation claim.

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Prescription of antipsychotics also maintained a growth trend (Health System Review – Portugal, 2018, pp. 11, 12). In 2019, the European Observatory on Health Systems and Policies issued a country health report on Portugal (EOHSP, 2019).10 Among its findings, it states that though life expectancy increased to 85 years old, the last 13 years are likely to be lived with some disability, particularly women, who live longer but less healthily than men. Levels of physical activity are low compared to the EU average (leading to an increase of noncommunicable diseases). Adult alcohol consumption and obesity levels are considered concerning. The existence of a National Health Service that provides universal coverage to the entire population is praised. Health spending has reverted its tendency and has significantly decreased, which is considered positive, though it is still above EU average. However, the two most significant challenges are the health system’s financial and fiscal sustainability. On the one hand, Portugal’s population above 65 years old tends to increase in the upcoming years, which will bring added pressure to the system. On the other hand, arrears continue to exert additional difficulties. Mental health is addressed with three main observations: the number of beds has decreased over time; a mix of private and public providers deliver primary care; and the Portuguese NHS has initiated a process to support integrated care in 1999 and has been continuing that process ever since. Overall, though main findings may sound reasonable, it is an optimist report when confronted with reality. Perhaps this stems from a combination of two things: the analysis is strictly sectoral—and even so, partial and data that would allow for a more comprehensive analysis was perhaps not easy to access, available or able to be facilitated. Let us now cross plans, programmes, diagnoses, strategies and recommendations issued by the EU and at a national level in the health sector. Do they share similar perspectives and solutions?

Conclusion (Tensions and Solutions) At the European level, we have focused mainly on the EU’s Public Health Programmes and the European Semester, a governance instrument created by the European Commission to monitor national economies.

10 See also OECD/ European Observatory on Health Systems and Policies 2017.

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Three stages can be identified: 1) In 1999, DG SANCO (DG Sante’s predecessor) was created to address the EUs public health. 2) The second stage takes place between 2003 and 2013. It encompasses the time when the first two EU Health Programmes are released. The first, between 2003 and 2007, specifically calls for an integrated intersectoral health strategy. The programme issued for 2008–2013 is based on a WHO report and has among its primary concerns NCDs that are identified as the leading cause of burden of disease in the European region (77%). 3) During the third stage, starting in 2014, DG SANCO is replaced by DG SANTE, and for the first time, in 2015, a new instrument is added, the European Semester. The third EU Health Programmw (2014–2020) and the EU4Health (2021–2027) are published. For the first time, these are now a Regulation instead of a Decision which makes its content more binding and accountable when it comes to assuring that national measures are put in place, considering the programme’s analysis. Governance wise, in the 3rd PHP, a National Focal Point is created in each country. These are responsible for providing up-to-date information to the EC and assuring that regulations are enforced through national public policies. The 2014–2020 Programme highlights mental health as one of its priorities stating that mental health accounts for almost 40% of years lived with disability. Reviewing evolution reports for all three EU Health Programmes, the most prevailing gap common to the first three PHP is a call for indicators and monitoring criteria/strategy. Low participation of poorer Member States is mentioned in the evaluation reports of the second and third Programmes. The 4th PHP, EU4Health, is highly significant in its comprehensive approach to mental health, which should be saluted and, hopefully, it is pursued further. The European Semester issued its first macroeconomic country-specific recommendation (CSR) to Portugal in 2015. Focusing on the health sector, high expenditure (above EU levels) is referred to in all reports between 2015 and 2019. Three main factors contribute to this: old-age dependence that is expected to increase significantly in the long term

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(2015, 2017 and 2019); a lack of adequate budgeting and a long-term strategy (2017 and 2018); and arrears (2016, 2017 and 2018). Accessibility is a frequently addressed topic, whether due to an uneven geographic distribution of health services or low-income populations having low access to health services (2016, 2017 and 2018). Between 2015 and 2018, the sustainability of the health sector versus its accessibility is the backbone of the ES’s evaluation. To overcome this, a strategy and long-term planning are perceived as a vital part of the solution. At the national level, we can also distinguish three stages: 1) 1998–2003: Concerning the programme “Health: A Commitment” (1998–2002), a 2002 evaluation report states that when it comes to mental health, there is a low intervention capacity, apart from hospitalisation, and that there is a lack of data available (the 2001 Census on mental health was conducted during one week having the possibility to provide some information, it does not provide reliable or significant information about the mental health sector). It states that there is a legislation gap in hospital organisation, and it announces for the first time the upcoming National Plan for Mental Health. It is praiseworthy that it openly calls for interinstitutional and intersectoral articulation and public–private articulation. In 2003, a new document on strategic orientations for the health sector was issued (by the new government in power) addressing mental health in broad terms, mentioning a lack of data and referring to stress as a problem to be tackled. Again, it announces a forthcoming National Plan for Mental Health. Taking a pioneering and commendable stand, the document includes a recommendation for an articulation between health, surrounding environment and architecture. This call for intersectoral cooperation features among main orientations in public health policies again in 2004, but it is not sustained to lack of data and research. 2) 2004–2010: The National Health Plan (2004–2010) proceeds to a summarised description of institutional and human resources available in mental health. It identifies as its main achievement what has been done concerning drug-related public policies put in place. Though related, I do not consider that it is a good option to put both items together because mental health issues demand a specific

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strategy different from the one to be implemented concerning drug use. They can be related but not always. To praise drug-related policies when describing mental health achievements can therefore lead to misinterpretation. In general, it is acknowledged that there is no integrated vision of the health system, that access is a problem and that the hospital network needs to be reorganised. These also apply to mental health, to which it adds a call for a focus on prevention and articulation between psychiatry and basic care units. The “Action Plan for Health 2004” claims once again that there is a lack of data regarding mental health. However, it features few and unsubstantiated statements. WHO’s external evaluation report of the Plan claims that the Plan did not address the sustainability of the health sector (financial and human resources) and that it had established too many goals. It highlights that a collaborative government approach should be put in place and that “steps will have to be taken to strengthen intersectoral action […] across government”. Critical policy gaps identified are system sustainability and access inequality. This confirms the main concerns addressed by ES’s country reports published between 2015 and 2018 corroborating a persisting lack of strategy and long-term planning where policies founded in intersectoral continue to be non-existent. The 2006 report on mental health (Ch I, S1, §15), though concise, it represents an essential stepping-stone for being the first serious attempt to provide a state of the art of the mental health sector at the national level. It states a lack of funding and human resources that there should be a better articulation with primary care and a lack of evaluation and monitoring instruments. 3) 2007–2020: This stage encompasses the National Plan for Mental Health/NPMH (2007–2016) and the National Health Plan (2012– 2016). Recently they have been both extended up until 2020. Having been mentioned for the first time in 2002, five years later, the NPMH was established. It called for geographic decentralisation of the network; creating alternatives to a non-hospitalisation policy that is community-based instead; more scientific research at the national level; and articulation with primary care. Its extension

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has been identified as priorities for 2017–2020, to establish a betterfinancing strategy; new governance and management strategies; more human resources; articulation with primary care; and close collaboration with the Ministry of Justice. The National Health Plan (2012–2016) hardly mentions mental health, perhaps due to the NPMH’s call for independent budgeting. Though this is not yet in place, perhaps the omission indicates that we are on the way to implement this. For the first time, several references to cities and healthy cities can be found. This is the first time to happen at a national level in a document that has as its main concern health. It is therefore noteworthy and highly relevant due to the scope of this book. The Plan’s extension up until 2020 adds intersectoral policies and healthy environments to its goals. WHO’s evaluation report (in 2015) mentions Healthy Cities as a positive initiative relevant to the health sector. In their 2018 report WHO links the onset of mental illness 10 to 15 years earlier in deprived areas (vs onset in affluent ones). Though EU and national stages do not coincide, because plans and programmes have different timelines, the recent national extensions of both the general health plan and the mental health plan up until 2020 indicate that there is an intention to synchronise national strategies with EU strategies. From 2020 onwards, this will be possible to achieve. We can also observe a growing tendency for EU initiatives and Programmes to use WHO and/or United Nations’ goals and strategies to define priorities in the realm of the EU—also increasingly impacting national public policies. The EC’s Health Programmes evolution shows that there will be an increasing stress on convergence concerning public health policies and that further national accountability mechanisms can be expected to be developed. Representing a significant part of budget expenditure, it is anticipated that the ES will continue to call for long-term strategies for the health sector to assure sustainability and access equality. At a national level, the need to reorganise the hospital network is among the most constant statements. This also impacts the existing mental health network being the 2007–2020 strategy to increasingly incorporate mental health care into general hospitals. For this to happen, the law issued in 1999 that created local services for mental health (SLSM) and regional services for mental health (SRSM) needs to be put

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into practice. This measure relates unequivocally with spatial and regional planning policies. Consequently, so that any mental health policy can be successful, growing intersectoral collaboration with this sector can be projected. The current book presents a state of the art of both sectors (health and spatial planning), claiming that an intersectoral collaboration is inevitable and necessary. Evaluation indicators and monitoring are called for in every Health Programme up until now. Also, National Focal Points need to report adequately to the EC, better articulating recommendations with national policies. At a national level, it is frequently reported the need for more data, including indicators. Therefore, to monitor and to be able to create new strategies, the need to develop and implement them is vital. Anticipating an increase in intersectoral collaboration (that is called for both in the EU and Portugal), particularly between health and spatial planning, new indicators need to be put in place to monitor progress.

References Bento, A., Carrera, M., & Heitor, M. J. (2001). Censo Psiquiátrico de 2001. Síntese dos resultados. Ministério da Saúde, Direcção-Geral da Saúde. https://www.dgs.pt/documentos-e-publicacoes/censo-psiquiatr ico-de-2001-.aspx Caldas de Almeida, J. M., Mateus, P., Xavier, M., & Tomé, G. (2015). Joint acton on mental health and well-being. Towards community-based and socially inclusive mental health care. Análise da situação em Portugal. Sociedade Portuguesa de Geriatria e Gerontologia Website. http://spgg.com. pt/UserFiles/file/23_09_15report_JA_em_PORTUGUES.pdf Clemens, T., Sørensen, K., Rosenkötter, N., Michelsen, K., & Brand, H. (2017). The directorate-general for health and consumers 1999–2014: An assessment of its functional capacities. Health Policy, 121(6), 594–603. https://doi.org/ 10.1016/j.healthpol.2017.03.018 CD. Commission Decision 1786/2002/EC. (2002). Decision No 1786/2002/EC of the European Parliament and of the Council of 23 September 2002 adopting a programme of Community action in the field of public health (2003–2008). Official Journal of the European Communities, L 271/1, 9.10.2002. CELEX number: 32002D1786. https://eur-lex.eur opa.eu/ CD. Commission Decision 2004/858/EC. (2004). Commission Decision of 15 December 2004 setting up an executive agency, the ‘Executive Agency for the Public Health Programme’, for the management of Community action in the field of public health — pursuant to Council Regulation (EC)

50

D. SOEIRO

No 58/2003. Official Journal of the European Communities, L 369/73, 16.12.2004. CELEX number: 32004D0858. https://eur-lex.europa.eu/ CD. Commission Decision 1350/2007/EC. (2007). Decision No 1350/2007/EC of the European Parliament and of the Council of 23 October 2007 establishing a second programme of Community action in the field of health (2008–13). Official Journal of the European Communities, L 301/3, 20.11.2007. CELEX number: 32007D1350. https://eur-lex.eur opa.eu/ CD. Commission Decision. (2018). 4492 final (2018). Commission Decision of 17.7.2018 setting up a Commission expert group “Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases” and (…). European Commission. https://ec.europa.eu/health/ sites/default/files/major_chronic_diseases/docs/c2018_4492_en.pdf CNRSSM. Comissão Nacional para a Reestruturação dos Serviços de Saúde Mental. (2007). Relatório da Comissão Nacional para a Reestruturação dos Serviços de Saúde Mental (April). www.hmlemos.min-saude.pt/docs/PNacSM 2007.pdf CTARSM. Comissão Técnica de Acompanhamento da Reforma da Saúde Mental. (2017). Relatório da Avaliação do Plano Nacional de Saúde Mental 2007– 2016 e propostas prioritárias para a extensão a 2020 (Julho). Serviço Nacional de Saúde Website. https://www.sns.gov.pt/wp-content/uploads/2017/08/ RelAvPNSM2017.pdf DG SANCO. (2011). Ex-post evaluation of the Public Health Programme (PHP) 2003–2008. Final report (March). https://ec.europa.eu/health/sites/ health/files/programme/docs/ex_post_evaluation_en.pdf DG SANTE. (2015). Ex-post evaluation of the health programme (2008–2013). Final report (Ref. Ares (2015)3227899 - 31/07/2015). https://doi.org/10. 2875/476930 DG SANTE. (2017). Mid-term evaluation of the third health programme (2014– 2020). Publications Office of the European Union. https://doi.org/10. 2875/359384 DGO. Direcção-Geral do Orçamento. (2019). Ministério – Despesa de 2018. http://online.dgo.pt/DadosCidadao/Orcamento_CG.Entrada.aspx EC. European Commission. (2017). Mid-term evaluation of the 3rd Health programme 2014–2020 under Regulation (EU) No 282/2014 on establishing a third programme of Union action in the field of health (2014–2020). SWD (2017) 333 final, 11.10.2017. https://ec.europa.eu/health/sites/hea lth/files/programme/docs/2014-2020_evaluation_cswdexe_en.pdf EC. European Commission. (2019a). European Commission – Business, economy, euro. https://ec.europa.eu/info/business-economy-euro/economic-and-fis cal-policy-coordination/eu-economic-governance-monitoring-prevention-cor rection_en

3

HEALTH

51

EC. European Commission. (2019b). Business, Economy, EuroEconomic and fiscal policy coordination. EU Economic governance: Monitoring, prevention, correction. Macroeconomic imbalance procedure. In-depth reviews [Country Reports]. https://ec.europa.eu/info/business-economy-euro/economicand-fiscal-policy-coordination/eu-economic-governance-monitoring-preven tion-correction/macroeconomic-imbalance-procedure/depth-reviews_en EC-DGEFA/ European Commission - Directorate-General for Economic and Financial Affairs. (2015). European Economy. Macroeconomic imbalances Country Report – Portugal 2015. Occasional Papers 222: Directorate-General for Economic and Financial Affairs. https://ec.europa.eu/economy_finance/ publications/occasional_paper/2015/pdf/ocp222_en.pdf EC-DG Sante. (2019). What we do - Directorate-General - Sante. European Commission. https://ec.europa.eu/info/departments/health-and-foodsafety/what-we-do-health-and-food-safety_en EC Country Report. (2016). Country Report Portugal 2016. Including an In-Depth Review on the prevention and correction of macroeconomic imbalances. 26.2.2016 SWD (2016) 90 final. https://ec.europa.eu/info/bus iness-economy-euro/economic-and-fiscal-policy-coordination/eu-economicgovernance-monitoring-prevention-correction/macroeconomic-imbalancesprocedure/depth-reviews_en EC Country Report. (2017). Country Report Portugal 2017. Including an In-Depth Review on the prevention and correction of macroeconomic imbalances. 22.2.2017 SWD (2017) 87 final. https://ec.europa.eu/info/bus iness-economy-euro/economic-and-fiscal-policy-coordination/eu-economicgovernance-monitoring-prevention-correction/macroeconomic-imbalancesprocedure/depth-reviews_en EC Country Report. (2018). Country Report Portugal 2018. Including an In-Depth Review on the prevention and correction of macroeconomic imbalances. 7.3.2018 SWD (2018) 220 final. https://ec.europa.eu/info/bus iness-economy-euro/economic-and-fiscal-policy-coordination/eu-economicgovernance-monitoring-prevention-correction/macroeconomic-imbalancesprocedure/depth-reviews_en EC Country Report. (2019). 2019 European Semester: Country Specific Recommendation / Commission Recommendation - Portugal. 5.6.2019 COM (2019) 522 final. https://ec.europa.eu/info/business-economy-euro/ economic-and-fiscal-policy-coordination/eu-economic-governance-monito ring-prevention-correction/macroeconomic-imbalances-procedure/depth-rev iews_en EC Public Health. (2019a). Public Health. Live, work, travel in the EU. European Commission. https://ec.europa.eu/health/home_en

52

D. SOEIRO

EC Public Health. (2019b). Non-communicable diseases. Public Health. Live, work, travel in the EU. European Commission. https://ec.europa.eu/health/ non_communicable_diseases/overview_en EC Public Health. (2019c). EU Health Programme. Public Health. Live, work, travel in the EU. European Commission. https://ec.europa.eu/health/fun ding/programme_en EC SGPP. (2019). Steering Group on Promotion and Prevention, or SGPP. Non-communicable diseases. Public Health. Live, work, travel in the EU. European Commission. https://ec.europa.eu/health/non_communicable_dis eases/steeringgroup_promotionprevention_en EOHSP. (2019). State of Health in the EU, Portugal – Country Health profile 2019. European Observatory on Health Systems and Policies. https://eur ohealthobservatory.who.int/publications/m/portugal-country-health-profile2019 ES. European Semester. (2019). The framework - The EU’s economic governance explained. https://ec.europa.eu/info/business-economy-euro/eco nomic-and-fiscal-policy-coordination/eu-economic-governance-monitoringprevention-correction/european-semester/framework/eus-economic-govern ance-explained_en Frias, P., & Pinto da Costa, M. (2020). Community psychiatry in Portugal: A critical review. Consortium Psychiatricum, 1(1), 49–59. https://doi.org/10. 17650/2712-7672-2020-1-1-49-59 Health System Review – Portugal. (2018). Final Report (April), World Health Organization. Serviço Nacional de Saúde Website. https://www.sns.gov. pt/wp-content/uploads/2018/04/PortugalReviewReport_Printers_03Apri l2018-2.pdf Heitor dos Santos, M. J., Gusmão, R., Ferreira, S., & Santos, M. (2006). “Portugal”. In E. Jané-Llopis & P. Anderson, (Eds.), Mental health promotion and mental disorder prevention across European Member States: A collection of country stories (pp. 129–134). European Communities. http://europa.eu. int/comm/health/ph_determinants/healthdeterminants_en.htm Ministério da Saúde. (2002). Ganhos de Saúde em Portugal – Ponto de situação. Relatório do Director-Geral e Alto-Comissário da Saúde. Março. Ministério da Saúde, Direcção Geral da Saúde. https://www.dgs.pt/documentos-epublicacoes/ganhos-de-saude-em-portugal-ponto-da-situacao-relatorio-do-dir ector-geral-e-alto-comissario-da-saude.aspx Ministério da Saúde. (2003). Plano Nacional de Saúde. Prioridades para 2004– 2010 (Dezembro). https://www.dgs.pt/documentos-e-publicacoes/planonacional-de-saude.aspx Ministério da Saúde. (2004a). Plano Nacional de Saúde. Prioridades para 2004– 2010 (11 Fevereiro). https://www.dgs.pt/documentos-e-publicacoes/planonacional-de-saude1.aspx

3

HEALTH

53

Ministério da Saúde. (2004b). Plano Nacional de Saúde. Orientações Estratégicas para 2004–2010 (11 Fevereiro). https://www.dgs.pt/documentos-e-pub licacoes/plano-nacional-de-saude2.aspx Ministério da Saúde. (2004c). Plano Nacional de Saúde. Prioridades para 2004–2010 (Julho). https://www.dgs.pt/documentos-e-publicacoes/planonacional-de-saude-2004-20101.aspx Ministério da Saúde. (2004d). Plano Nacional de Saúde. Orientações Estratégicas para 2004–2010 (Julho). https://www.dgs.pt/documentos-e-publicacoes/ plano-nacional-de-saude-2004-2010.aspx Ministério da Saúde. (2004e). Plano de Acção para a Saúde 2004 – Áreas prioritárias (Março). https://www.dgs.pt/documentos-e-publicacoes/planode-accao-para-a-saude-2004-areas-prioritarias.aspx Ministry of Health. (2003). Contributions to the National Health Plan – Strategic Guidelines 2003 (31.01.2003). https://www.dgs.pt/documentos-epublicacoes/national-health-plan-english-version.aspx Ministry of Health. (2004). National Health Plan 2004–2010. Volume I – Priorities (July). https://www.dgs.pt/ficheiros-de-upload-1/pns-versao-ingles-dez 2004-pdf.aspx National Health Plan 2012–2016. (2013). Summarised version (May). Lisboa: Direcção-Geral de Saúde. https://pns.dgs.pt/nhp-in-english/ OECD/ European Observatory on Health Systems and Policies. (2017). Portugal: Country Health Profile 2017, State of Health in the EU . OECD Publishing, European Observatory on Health Systems and Policies. https:// doi.org/10.1787/9789264283527-en OECD/EU. (2018). Health at a glance: Europe 2018: State of Health in the EU Cycle. OECD Publishing. https://doi.org/10.1787/health_glance_eur2018-en Perelman, J., Chaves, P., Caldas de Almeida, J. M., & Matias, M. A. (2018). Reforming the Portuguese mental health system: An incentive-based approach. International Journal of Mental Health Systems, 12, 25. https:// doi.org/10.1186/s13033-018-0204-4 Plano Nacional de Saúde. (2015). Revisão e extensão a 2020 (Maio). DiecçãoGeral de Saúde. https://pns.dgs.pt/pns-revisao-e-extensao-a-2020/ Plano Nacional de Saúde Mental 2007–2016. (2008). Resumo Executivo (Julho). Coordenação Nacional para a Saúde Mental. Ministério da Saúde, Alto Comissariado da Saúde, Coordenação Nacional para a Saúde Mental. https://www.adeb.pt/files/upload/paginas/Plano%20Naci onal%20de%20Saude%20Mental.pdf Portuguese National Health Plan. (2015). Interim Report on the National Health Plan: Revision and Extension to 2020 (The NHP-Revision) Comments from WHO Europe. World Health Organization. https://www.dgs.pt/ficheiros-deupload-2/pns-evaluation-pdf.aspx

54

D. SOEIRO

Programa Nacional para a Saúde Mental. (2017). Direção-Geral da Saúde Website. Ministério da Saúde. https://www.dgs.pt/portal-da-estatistica-dasaude/diretorio-de-informacao/diretorio-de-informacao/por-serie-885309pdf.aspx?v=11736b14-73e6-4b34-a8e8-d22502108547 Regulation. (2014). Regulation (EU) No 282/2014 of the European Parliament and of the Council of 11 March 2014 on the establishment of a third Programme for the Union’s action in the field of health (2014–2020) and repealing Decision No 1350/2007/EC. Official Journal of the European Communities, L86/1, 21.3.2014. CELEX number: 32014R0282. https:// eur-lex.europa.eu/ Regulation. (2021). EU Health Plan, EU4HHealth. Regulation (EU) 2021/522. European Commission. https://ec.europa.eu/health/funding/eu4health_en WHO. (2010). Evaluation of the National Health Plan of Portugal (2004–2010). WHO Regional Office for Europe. World Health Organization – Regional Office for Europe Website. https://www.euro.who.int WHO. (2011). NCD global monitoring framework. World Health Organization Website. https://www.who.int/publications/i/item/ncd-surveillance-glo bal-monitoring-framework WHO. (2013). Mental health action plan 2013 – 2020. World Health Organization Website. https://www.who.int/publications/i/item/9789241506021

CHAPTER 4

Spatial and Urban Planning

Spatial and Urban Planning in the European Union EU Cohesion as Regional Policy, from the Treaty of Rome (1958) up Until 2007 In the context of the EU, spatial and urban planning are part of the framework that allows political and economic union to be established. Its role is progressively acknowledged as key to accomplishing the EU’s goals, from the foundation of the Directorate-General for Regional Policy (DG REGIO) in 1968 to a cohesion policy started in 1989, to one of the most recent initiatives where an active organisation of space is envisioned, the Territorial Agenda of the EU (TAEU), launched in 2007. As the EU unfolds, several programmes and initiatives actively address space as a key element to accomplish its ambitions. Therefore, it can be stated that over time, there has been a growing role of spatial and urban planning policies in the context of the European Union. As the spatial component of the EU gets increasingly more complex, it is, therefore, helpful to map it out. On the one hand, we have a regional policy acknowledged as foundational of the EU since the beginning with DG REGIO (1968), aimed at coordinating national policies. The first fund allocated to correct imbalances between countries and regions was established in 1975, the European Regional Development Fund (ERDF). The gradual expansion of the EU project led to the creation of a cohesion policy in 1989 aiming © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 D. Soeiro, Cities, Health and Wellbeing, Sustainable Urban Futures, https://doi.org/10.1007/978-3-030-89348-4_4

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at strengthening economic, social and territorial cohesion in the European Union (see Fig. 4.1, EU cohesion policy and regional policy. Elaborated by the author). On the other hand, we have programmes that directly envision to encourage a particular spatial dynamic among Member States (like Interreg (1989); Interact (2002); and URBACT (2002)) and initiatives by EU Ministers for Urban Development and Regional Planning that have been rapidly expanding since 2007, in the aftermath of the creation of the European Observation Network for Territorial Development and Cohesion (ESPON) in 2002 (see Fig. 4.2, EU Spatial and Urban Planning Policies. Elaborated by the author). Following American geographer Edward Soja (2010), this means that now space is being used as an active element able to positively determine what happens in different areas, actively contributing to achieving goals in other areas, instead of being a passive element where simply things occur. As regional and territorial European policies take shape, playing an increasingly important role among EU policies, could we say that they now shape social and political events? An active role of space is deeply rooted in the origins of the EU (topdown). Still, it also plays a significant role in acting as resistance to the EU

Fig. 4.1 EU cohesion policy and regional policy (Elaborated by the author)

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Fig. 4.2 EU Spatial and Urban Planning Policies. (Elaborated by the author)

project being perceived as able to preserving national identity (bottom up) (Keating, 2008). Are these two approaches to space compatible? Can they be somehow complimentary? By definition, “territory is something shaped by, and a shaper of, continual processes of transformation, regulation and governance” (Elden, 2013, p. 17). Does European spatial policy embody this definition? Let us briefly review its history. In the aftermath of the Second World War and intending to avoid any other major conflict in Europe, six European countries signed the Treaty of Paris (1951), establishing the European Coal and Steel Community (ECSC)—Belgium, France, Germany, Italy, Luxembourg and the Netherlands. This integration experiment was circumscribed to the coal and steel market, but it clearly stated that it meant to be one first step in the direction of a European Federation. The Treaty of Rome (1958), agreed upon by the same countries, expanded the previous content. On its first page, it presented its general framework that could be said to sum up what is the EU project up until today. Ambitiously, it stated that those who subscribe to it were determined to build an ever-closer union; resolved to ensure economic and social progress; committed to affirming a constant improvement of the living and working conditions; anxious to strengthen the unity of their economies and to ensure their harmonious development; recognising and desiring a steady expansion, balanced trade, fair competition and progressive abolition of restrictions on international trade; intending to confirm the Treaty as a solidary project desiring to ensure the development of

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their prosperity, in accordance with the principles of the Charter of the United Nations; resolved to preserve and strengthen peace and liberty. Towards the accomplishment of the outlined ambition, the Treaty aimed at: (1) establishing a common market based on the four freedoms of movement (goods, persons, capital and services)—European Economic Community (EEC); and (2) assuring a peaceful use of nuclear energy—European Atomic Energy Community (EAEC, otherwise known as “Euratom”). The Treaty also laid down principles for common policies on agriculture (Articles 38 to 43), transport (Articles 74 and 75) and commerce (Articles 110 to 113). It created the European Social Fund and the European Investment Bank. In it, we find a reference to “regional economic policy” (Article 80, n.2) as a criterion to assess and authorise particular undertakings or industries pursued by any given Member State. In 1965, the Treaty of Brussels (Merger Treaty) merged all three executive institutions (ECSC, EEC and Euratom) exclusively under the “European Economic Community” (EEC), affirming the intention behind the treaties as one (Sokolska, 2021). Aiming at broadening its scope of action, shortly after, the EEC created several Directorates to address different sectors, among them, the Directorate-General for Regional Policy (DG REGIO), in 1968. The European Regional Development Fund (ERDF) was established in 1975 to support regional policy projects and programmes that contribute to reducing inequalities among Member States, under the solidarity principle that sustains the organisation since the Treaty of Paris (1951). A significant step in the European integration process was the Maastricht Treaty (1993). Renaming the “EEC” as “European Union”, at this point, six more countries were part of the organisation: Denmark, Ireland, United Kingdom, Greece, Spain and Portugal. The Treaty created the Cohesion Fund, the Committee of the Regions. It stated the principle of subsidiarity, assuring that each Member State retained its decision power on all occasions except if its member(s)’ power revealed itself as insufficient. (The Treaty was amended by the Treaty of Amsterdam (1999), Treaty of Nice (2003) and Treaty of Lisbon (2009)). European cohesion, across all sectors, is an early ambition of the European integration process. In 1989, structural funds were specifically allocated to support programmes that advance cohesion policy. Its second package (1994–1999) was designed in the aftermath of the newly created “Cohesion Fund” by the Maastricht Treaty (1993), assigning one-third

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of the EU budget, and this has been roughly the case since then (EC, 2021).1 Albrechts (1997) claims that spatial policy, up until the late 1990s, had not been a focal point of development of the EU though it is possible to trace its growing relevance (Anonymous, 1996). Though spatial policy was addressed in the Treaty of Rome (1958), the1990s first reflects an interest of European institutions in transnational cooperation. First, with two studies promoted by European Commission, Europe 2000 (1991) and Europe 2000 + (1994). Later on, in 1999, the European Spatial Development Perspective (ESDP) specifically addressed social exclusion and spatial segregation though the planning was “implicit, uncoordinated and dispersed in many sectoral theories” (Albrechts, 1997, p. 158). Presenting a detailed account of the discussion at the time, Healey (2004) seemed to support this perspective. In this case, the author considers that the documents did spark a resurgence of the debate of spatial policy. Ferrão (2010) agrees that these documents were vital to set up a new spatial planning culture reminding us of the role of CEMAT,2 meetings, promoted by the Council of Europe.3 Under the request of the Committee of Ministers of the Council of Europe, CEMAT meetings are specialised Ministerial Conferences that gather European Ministers responsible for Spatial/Regional Planning. Between 1970 and 2017, 17 meetings took place. One of them (the 6th) pioneered a joint spatial planning agreement, the European Regional/Spatial Planning Charter (Torremolinos Charter), in 1983 (Council of Europe, 2021). Within the framework of the EU, the European Spatial Development Perspective (ESDP), issued in 1999, was the first document that stemmed from an initiative of the European Ministers responsible for Spatial Planning. It aimed at agreeing upon common objectives and concepts for the future development of the territory of the EU. Faludi (2021) acknowledges that the ESDP attempted to design a regional policy but claims that “rather than formulating a truly joint vision, member states each looked primarily after their own interests”. I consider that this account implies judging the document based on higher expectations than the ones set by 1 Currently, the sixth package, 2021–2027, confirms this representing e330.2 billion out of a total of e1074.3 billion (Consilium, 2021). 2 Conference of Ministers responsible for Spatial/Regional Planning. 3 Unrelated to the European Union, the Council of Europe was founded in 1949, and

it aims at promoting human rights, democracy and the rule of law.

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those who drafted the document. My understanding of the document is that it aimed at expressing an agreement concerning the state of the art, describing what is the EU territory at that stage—and not so much to draft a common agenda. It was an official document that first presented the opportunity for other countries to access an accurate description of each Member State. This is why all policy options presented in the ESDP have a broad scope. They presented premises that intended to orient more detailed future documents and agreements concerning spatial policy. Any disappointment with ESDP may stem from acknowledging that a more detailed action-oriented plan was needed, but at the time, there was still no foundations that allowed it. In its aftermath, different instruments became available that directly or indirectly impacted each Member State’s spatial and urban planning. Since 2000, there are four interregional cooperation programmes that promote the European Territorial Cooperation goal (ETC) through urban and regional policy—ESPON, Interact, Interreg Europe and URBACT (URBACT, 2021). Starting the same year as cohesion policy, Interreg Europe was created in 1989, offering “opportunities for regional and local public authorities across Europe to share ideas and experience on public policy in practice” (Interreg, 2021). In 2002 three other programmes were launched. Interact, funded by ERDF, focuses on service delivery to support cooperation programmes (Interreg, Interreg IPACBC and ENI CBC), fostering new ways of cooperation. URBACT is a European exchange and learning programme promoting sustainable urban development. ESPN is the European Observation Network for Territorial Development and Cohesion. The four interregional programmes are aimed at supporting a regional policy rooted in the cohesion policy by fomenting action, mobilising actors and promoting experiments (Interact) by facilitating learning (Interred and URBACT) and evaluation and monitoring activities (ESPN). In 2004, with the integration of ten eastern European countries, the EU went from 15 to 25 Member States. Cohesion policy and its closely associated instrument, regional policy, required reinforcement. Since its establishment, this was the most significant spatial change of the EU. How to assure the integration of these countries? Territory becomes a pivotal element to answer this. In 2007, two important documents were issued: the Leipzig Charter, focusing on urban planning and the Territorial Agenda of the EU (2007–2013), with a broader scope addressing

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spatial planning. Both stem from a joint enterprise of European Ministers in charge of those cabinets. The Emergence of “Territorial Cohesion” in Key EU Documents in the Midst of the 2008 Financial Crisis, 2007–2009 The EU envisions fostering economic and social development of its Member States. Following the adoption of a single currency in 1999 (the Euro) and facing the beginning of a new millennium, the Lisbon Strategy (2000–2010) presented an ambitious vision that aimed to orient the EU’s cohesion policy. It established as priorities “growth, jobs and innovation”. That time period was known to carry significant challenges at the national level due to the recent adoption of the Euro by 12 of its 15 Member States—as much as it carried promising advantages to strengthen the EU’s common market. However, the Lisbon Strategy’s goals were also severely hampered by the impact of the global 2008 financial crisis. Its follow-up, Europe 2020 Strategy (2010–2020), reviewed the Lisbon Strategy priorities’ presenting a “smart, sustainable and inclusive growth” plan. Judging only on the three keywords used to sum up, each strategy it is noticeable that there is a rhetorical shift. The social impact of the crisis generated distrust in the EU project, and Member States’ citizens questioned the basic foundations of the Union: solidarity (Roth et al., 2011; Torreblanca & Leonard, 2013). This directly stemmed from severe austerity measures imposed to favour a tight control of public spending to control the impact of the crisis. As the crisis progressed, these were complemented with stimulus policies that urged governments to increase public spending through borrowing to create employment, maintain incomes and stimulate consumption (Midgley, 2014). Overall, the combined impact of both policies deepened a previous existing inequality severely impacting southern tier countries (Greece, Italy, Portugal, Spain) and Ireland, causing a significant increase in sovereign debt and compromising growth, affecting generations to come. The initial crisis of the banking system generated a sovereign debt crisis, which in turn translated into a stark regional imbalance among EU Member States (Ali, 2012; Callan et al., 2011; Hadjimichalis, 2011). According to the contagion principle, this internal inequality within the EU not only questioned the EU’s ability to sustain its integration as it weakened the EU’s role in global geopolitics. This awakened the old divide that haunts the EU since the beginning between Eurosceptics

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and pro-Europeans, often mediated by tough negotiations and sometimes only reaching consensus by agreeing on opt-outs (Adler-Nissen, 2014; Lak, 2020; Serricchio et al., 2013). To some, the crisis was the best possible argument to finally show that the EU was doomed to fail; to others, it highlighted the importance of mutual support among all Member States. Supporting the continuity of the EU, at a high level, what was agreed upon was that it was essential to promote fiscal coordination preventing sovereign debt of southern tier countries from negatively impacting the EU project (on a multi-authored discussion of EU’s public debt see Banque de France, 2012). The 2008 financial crisis had a regressive impact on economic and political institutions generating both a financial crisis and a crisis of representative democracy. For example, comparing business cycles and trends for Germany and Portugal in the period 1991–2018, Costa et al. (2021) conclude that not only do common shocks have asymmetric consequences, but also temporary shocks have permanent effects on the Portuguese economy.4 This allows authors to question macroeconomic cohesion policies among Member States as being place-neutral. Many waves of protest began in the immediate aftermath of the global financial crisis and continue now for more than a decade. The social transformation of the EU and the demands for a democratic renewal calls for a vigorous social policy (Fominaya, 2017; Midgley, 2014; Theodore, 2020). Cities played a significant part during the financial crisis, having been severely hit, but, in its outcome, its’ inhabitants came to be perceived as a key element to surmount it, having created alternative governance systems that privileged local communities and regional initiatives over centralised decision-making systems (Donald et al., 2014; Schipper & Schönig, 2016). Social transformation and democratic renewal were now embodied in cities across Europe, and there was a rhetorical shift in EU’s programmes and initiatives. Beforehand, the rhetoric adopted followed 4 The Portuguese economy was not at a high when the 2008 financial crisis hit, which contributed to a diminished resilience. Since the 1990s, inappropriate incentives increased resource misallocation at industry and firm levels, exacerbating market inefficiencies. Firms have a hard time incorporating R&D and promoting internationalisation strategies. The public sector performs insufficient policy evaluation, and it has a tendency to change policies when a new government takes charge. This explains why Portugal has a lower level of productivity up until today than advanced economies though it has experienced improvement at some levels. This slowdown in productivity is associated with a slower improvement of living standards. (see Alves, 2017).

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mainstream Economics where development equals “growth”.5 In the aftermath of the crisis, a rhetoric prioritising “prosperity” over “growth” seemed to gain momentum attempting to balance economic, ecological and social realms (Jackson, 2011; Meadows et al., 2004). Up to which extent were European cities ready to be recipients of such empowerment? Had the EU previously implemented mechanisms that enabled such empowerment to come to fruition? The EU’s balance between top-down decision-making and bottom-up initiatives has been hard to find. In the 2001 White Paper on “European Governance” presented by the European Commission (COM [2001] 428, 25.7.2001; EC-EG, 2001), this is acknowledged very clearly, stating that “the starting condition for more effective and relevant policies” (p. 3) is to foster a connection between Europe with its citizens. In other words, there is an acknowledgement that this connection either is non-existent or, at best, it needs to be strengthened (“many Europeans feel alienated from the Union’s work”, p.7). It is also pointed out that citizens expect the Union to act as visibly as national governments. This way of phrasing it makes it sound like an unfounded expectation, which indirectly confirms that the EU is a top-down institution operating at such a high level that those “below” seem to be unaware of its existence. How to involve citizens in shaping and delivering EU policy? The strategy delineated in the White Paper is critically assessed by Scharpf (2001), who claims that one significant thing that the document does not seem to be sufficiently interested in is in two modes of governance—“closer cooperation” and “open coordination” and these are vital to assure an integration that develops under the motto of diversity. This highlights the EU’s difficulty with connecting top-down and bottom-up decision models.

5 In the nineteenth century, fluctuations and prediction errors were commonly attributed to “psychological” factors. In the transition of the nineteenth to the twentieth century, this connection weakened, and the mathematisation of Economics took place, like in many other disciplines. Modelling was the way forward, and a given standard agent became representative of a Rational Expectation embodying the Rational Choice. In the 1950s, outside mainstream economics, this approach started being questioned. Since the 1990s, behavioural economics is the most significant trend in mainstream economics, integrating insights from psychology and analysing what happens in markets populated by agents which do not conform to standard criteria of rationality (Geiger, 2015). For better or for worse, Economics is a social science.

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Along with Scharpf (2006), I agree that economic integration needs to be articulated with modes of political integration that can accommodate a greater degree of national heterogeneity than is presently thought acceptable. For that to occur, the democratic legitimacy of the multilevel European polity can only come from accepting differentiated integration. Do we get closer to achieving that by combining a cohesion policy based on a regional policy increasingly propelled by spatial and urban planning? From an EU Cohesion Policy Based on Regional Cohesion to an Urban-Centred Cohesion Policy, Since 2009 The year 2009 is particularly significant to advance urban and spatial planning in a European context. Signed in 2007, the Treaty of Lisbon (2009) is composed of two treaties. The Treaty on European Union or TEU amends the Maastricht Treaty (1993), and the Treaty of Rome (1958) is now known in its updated form as the Treaty on the Functioning of the European Union or TFEU. The Treaty of Amsterdam (1999) featured for the first time the expression “territorial cohesion” when stating that EU Members should pursue economic and social interests “on the basis of principles and conditions which enable them to fulfil their missions” (Article 2, n.8). However, the expression only has one occurrence, and therefore its understanding is vague. In the Treaty of Lisbon, “territorial cohesion” is featured in both treaties and the TFEU, the Treaty that amends the foundational Treaty of Rome, for the first time in a key EU document, the expression is consistently used, holding place next to two other keywords for the EU integration “economic, social and territorial cohesion” (see in particular Articles 174–178). This finally makes the connection that has been implicit for so long, declaring the vital role that an active design of the European territory has to achieve economic and social cohesion. The Green Paper on Territorial Cohesion (2009) further confirms this, detailing what was established by the Treaty of Lisbon. One of the strategies to advance territorial cohesion was to create more detailed territorial levels (NUTS1, NUTS2 and NUTS3) as a way to improve policy intervention, facilitating access to funding at a more local level. Coordinated spatial and economic development were now observed as being intrinsically linked. Moreover, the scale-down of European territorial instruments pave the way for a more prominent role of cities (Let us remind that the document was issued in the aftermath of the 2008 financial crisis, which,

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as I argued, generated a rhetorical paradigm change from “growth” to “prosperity”). By 2009, European spatial policy had gone from a regional policy that aimed to foster balance among Member States (having little or no specific content on how to achieve this) that at some point both supported and meant to support a cohesion policy, culminating in the concept of “territorial cohesion”. This concept recognises that an active use of space has the ability to strongly influence economic and social cohesion. Spatial policy becomes a priority and a leading element to promote integration and equality among Member States, instead of being a passive component that is one more element featured in other sectors. Economic and social cohesion of European territories was now, unequivocally, territorial. With the operationalisation of the scale-down provided by “territorial cohesion”, the importance of cities becomes undeniable. The year 2009 was also when Commissioner for Regional Policy, Johannes Hahn, took office of DG REGIO. Highly aware of the evolution of regional policy in the context of the EU, and due to his experience in the Land and city of Vienna, in 2013, he decided to take a very significant initiative changing the name of Directorate-General for Regional Policy (DG REGIO) to the Directorate-General for Regional and Urban Policy (see Hahn, 2012, Ch. 7; Pazos-Vidal, 2019). Orienting urban planning, the Leipzig Charter (2007) was followed by the Urban Agenda for the EU (UAEU, Pact of Amsterdam, 2016) and by the New Leipzig Charter (NLC, 2020). The Territorial Agenda had two follow-up strategic documents in spatial planning, Territorial Agenda 2020 (2010–2020) and Territorial Agenda 2030 (2020–2030). Urban and spatial planning were now a necessary element to understand the future of the EU. At this point, the main question that arises is this: are these documents aiming at creating a uniform planning system all over Europe, or are they providing a framework where existing national planning systems remain intact? (Albrechts, 1997) Is European spatial policy complementary, empowering the local level and coordinating EU spatial activities or is it being used to impose a blueprint where each Member State is assigned a specific role to play in the name of European “territorial cohesion”? Between 2007 and 2009, the EU clearly advanced “territorial cohesion”, and the concept was brought forth in the foundational EU document, the Treaty of Lisbon (2009); in documents that addressed

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spatial planning like the first Territorial Agenda (2007–2013) and the Green Paper on Territorial Cohesion (2009); and the Leipzig Charter (2007) that addressed urban planning. Unpredictably, at a time when the EU was moving forward, strengthening its territorial cohesion, the 2008 financial crisis severely fragmented the EU threatening the sustainability of its integration to its core. Nevertheless, there is a shift in the EU project during this period, and the root of cohesion policy becomes spatial and urban planning. The set of documents mentioned above aimed to define a new transition arena creating an agenda that developed sustainability and joint strategies. Since its foundation, the EU went from an abstract statement of intentions common to all territories to a macro-level regional strategy to a scaleddown territorial cohesion, recently articulated with a close-up level that emphasises the role of cities. The question is if the gap between spatial planning and strategic plans is being sufficiently and efficiently addressed (Albrechts, 2006). Are there governance mechanisms put in place that allow for the gap to be reduced? The current cohesion policy (2021–2027) emphasises ecology and social realms to the detriment of traditional economic goals (e.g. growth, jobs), establishing five priorities: a smarter EU, greener, carbon-free, connected, social and closer to citizens. In this formulation, “cohesion” is an ecological and social policy where cities are perceived as vital to stimulate global competitiveness. The economic factor has been slowly displaced from the binominal cohesion-regional policy to the new binominal cohesion-urban policy. The role of cities is reinforced by an increasingly detailed urban agenda and a Europeanisation of urban policy. The economic thought influencing the EU cohesion policy is nowadays sustained by cities. The assumption is that economic growth and development will spread from bigger cities to medium-sized cities, to smaller cities and towns within polycentric urban regions; and from there, it will spread to peripheral, remote and lagging areas (Ahrend et al., 2017). This process should take place to the benefit of their surrounding communities and rural areas rather than at the expense (p. 17). After years of limited success in bridging the gap between richer and poorer regions by focusing on poorer regions, can this new strategy that privileges the role of cities finally reduce inequalities among the EU? The most important document in the realm of spatial planning is the Territorial Agenda of the EU 2030 (TAEU, 2030) that “applies everywhere, focusing on mutual relations and people’s well-being” (p. 1). It

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provides orientation for strategic spatial planning and calls for strengthening the territorial dimension of sector policies at all governance levels aiming to contribute to the United Nations’ 2030 Agenda (p. 3). It frequently mentions that the urban scale of its priorities is addressed in the New Leipzig Charter (2020). Both documents have in common the idea of territorial cohesion and a place-based approach. This approach demands horizontal and vertical coordination, evidence-informed policymaking and integrated territorial development. Urban planning policies are outlined in the New Leipzig Charter mapping what good urban governance is, determining it as key to a successful implementation of the Territorial Agenda: urban policy for the common good, an integrated approach, participation and co-creation, multilevel governance and a place-based approach (p. 22). Operating at the level of partnerships and detailing specific action Plans to pursue, the Urban Agenda for the EU launched in 2016 has been defining thematic partnerships among EU cities, representing various governmental levels and stakeholders. Initially, in its pilot stage, it has defined specific measures to tackle inclusion of migrants and refugees, affordable housing, air quality and urban poverty (“Amsterdam Partnerships”); shortly after, in 2016, it established partnerships regarding circular economy, digital transition, jobs and skills in the local economy and urban mobility (“Bratislava Partnerships”); in 2017, it prioritised climate adaptation, energy transition, responsible and innovative public procurement and sustainable use of land and nature-based solutions (‘Malta Partnerships’); and the latest generation of partnerships, launched in 2019, favoured Culture and Cultural Heritage and Security in Public Spaces (“Vienna Partnerships”) (Futurium, 2021). The Urban Agenda is the most micro-level spatial planning instrument in the EU that strives to translate good policies, governance and practices from the EU level, to the Member State level, to city level. What seems unclear now is how to articulate a cohesion policy based on regional policy with its most recent understanding of the regional dimension as a city-focused policy. At the operational level, how to articulate the traditional understanding of NUTS regions and an alternative understanding of functional urban regions? (Rauhut & Humer, 2020, p. 2128).

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Spatial and Urban Planning in Portugal Grassroots Spatial Planning: Brief Account from the Nineteenth Century up Until 2007 Place-based spatial and urban planning policies are now key to implement the EU’s cohesion policies. At the EU level, many binding and nonbinding instruments directly or indirectly impact spatial and urban planning, like environment, energy, competition and maritime legislation; incentives to promote cohesion policy, rural development and transport policy; and broad multisectoral agenda and discourse setting documents (Dallhammer et al., 2018). Here I will present a brief account of policies directly addressing spatial and urban planning in Portugal to better contextualise current policies.6 In Chapter 6, I will examine whether health-related issues are specifically addressed. In 1856 and 1857, two epidemics (cholera and yellow fever) hit Portugal’s city capital Lisbon killing more than 6,000 inhabitants. The first law concerning spatial planning aimed to improve urban health by encouraging better housing and better circulation in public spaces by opening up streets and creating new squares, gardens and buildings (Decree n.10, 31 December 1864). It directed that a Plan for General Improvements was now mandatory for Lisbon, Porto and other district cities. It was issued shortly after King Louis I started his reign in 1861. Due to a shortage of technical and human resources, the first two plans were issued decades later: General Plan for Lisbon (1904) conceived by Ressano Garcia and General Plan for Porto (1915) by Barry Parker. The Plans were developed by engineers, architects and public health specialists, and volunteers who decided on aesthetics-related matters and supported several other specialists. This frail structure, along with a deficiency of resources and experience, generated a lack of coherence in designing and implementation of Plans, often generating public discord. In 1911, Portugal inaugurated its First Republic. Transitioning from a monarchy to a republic represented a period of social and economic upheaval. In 1932, António Salazar was appointed as prime minister of 6 I will use as primary reference Mota (2017). For a historical account of public policies from the nineteenth century up until the 2010s, see Fadigas (2015); a description of spatial planning policies, instruments and governance between the 1980s and 2005 is provided by Amaro Alves (2007).

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Portugal (1932–1968), which finally brought some stability. However, the country ended up being ruled by a corporatist authoritarian government (Estado Novo) up until 1974. Under the influence of several foreign specialists in urban matters hired as specialists during this period, two primary documents were issued. The first stated that all municipalities had to design a topographic map and present a general plan for urbanisation (Decree n.24:802, 12 December 1934). This applied to cities and “areas relevant for their touristic, recreational, climatical, therapeutic, spiritual, historic or artistic interest”. Following the suggestion of French urbanists, under Cornudet’s Law, this would also contribute to decreasing unemployment because public works could be co-financed by the unemployment fund. For the first time, the goal was to have the basic technical resources that would be able to describe the Portuguese territory (not only cities) and only then it would be possible to design an overarching national planning strategy. However, the law was not effective. The process was too slow, and there was a lack of a joint articulation between municipalities. In 1944, Duarte Pacheco (Minister for Public Works) issued a second decree renewing the previously published ruling (Decree n.33921, 5 September). It added that general urbanisation plans should aim to transform and develop the municipality, encouraging economic and social prosperity through better “aesthetics, hygiene and mobility”. By 1948 there were 28 preliminary plans, and in 1960, 234 were fully approved. In 1974, Portugal established a democratic government. The priority was to create new governance systems that would empower local and regional areas, and the first elections took place in 1976. Shortly after, in 1979, a new system for local finance was implemented. Providing basic infrastructures and healthy housing to the general population was the main resolution. The Municipal Master Plan (Plano Director Municipal/PDM ) was legally created in 1977 (Law n.79/77, 26 October) later on, detailed by José Viana Barreto and Gonçalo Ribeiro Telles7 (Decree n.208/82, 26 7 José Viana Barreto (1924–2012) was one of Portugal’s first Landscape Architects, and in 1953, he was the first to work at the government level for the Directorate-General for Urbanisation Services. His father, Lieutenant Colonel Álvaro Salvação Barreto, was Mayor of Lisbon’s City Hall between (1944 and 1959). In the early 1950s, he created a Landscape Architecture department, a pioneering initiative. Ribeiro Telles, also one of the country’s first Landscape Architects, who had studied with Viana Barreto, worked for the department and between 1951 and 1959 designed 93 green spaces (Barreto, 2011,

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May). It established that a Municipal Master Plan should present technical fundamentals for land use supported by a socio-economic strategy, including mechanisms for public participation. The law was issued; still, its implementation was not significant because the country’s recent democracy was economically struggling, newly elected local mayors were inexperienced and there was a severe shortage of specialised human resources. The law was reinforced by two other complementary laws, having Ribeiro Telles a key role in their formulation: National Agrarian Reserve (REN— Reserva Agrícola Nacional, Decree n.451/82) and National Ecological Reserve (RAN—Reserva Ecológica Nacional, Decree n.321/83) (Soeiro, 2019). Both were conceived as the basis of a national spatial planning strategy that placed agriculture and rural areas as its primary foundation, and second, privileging the ecological balance of ecosystems that should harmonise economic, social and cultural initiatives. The vision encompassed by these three documents was much needed and is intended to simultaneously provide a framework to articulate the local and national levels. For many decades, due to Portugal’s many economic and human resources frailties, this vision remained overlooked. REN and RAN have been revised several times over the years, but it has been hard to articulate them with other initiatives and legislation (Mendes, 2012). The principles that sustain Ribeiro Telles’ spatial planning approach did not match EU orientations for a long time. Still, particularly in the aftermath of COVID19 and the European Green Deal, it gains momentum: to prioritise land use for what is acknowledged as the critical immemorial economic activity, agriculture, also contributing to protect ecosystems and preserve landscape; and to subordinate all economic, social and cultural activities to a holistic ecosystem, local and nature-based, surrounding environment. In Ribeiro Telles’ vision, nature and rural space are the elements that organise all others. Up until the outbreak of COVID-19, EU orientations established that cities are the key elements that organise space due to their potential to harness economic and social resources. The idea behind it was, if the EU has thriving cities, their triumph will trickle down to pp. 5, 6). Gonçalo Ribeiro Telles (1922–2020) was State Secretary for the Environment in Provisional Governments I (1974) and IV (1975); Subsecretary for the Environment in the Provisional Governments II (1974) and III (1974–1975); and State Minister for Quality of Life in Constitutional Government VIII (1981–83) remaining politically active throughout his life striving to encourage legislation that would assure that economic and social development would be implemented following sustainability standards (Arquivo Histórico, 2021).

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adjacent areas, revitalising regions (Medeiros & Rauhut, 2020). Now, a renewed approach that understands the added value of rural areas has resurged. These are two contrasting approaches to spatial planning, but they are not necessarily incompatible. Portugal joined the European Economic Community in 1986, and to articulate investments supported by European funding, a more robust spatial planning was demanded. The first structural funds from the EU (1986–1988) privileged the modernisation of different economic sectors. The second (QCA I, 1989–1993) favoured professional qualification and vocational training. QCA II (1994–1999) explicitly prioritised initiatives that would both approach Portugal from the EU and reduce national, regional asymmetries (ADC, 2021). Structural funds unmistakably demanded a more tangible national spatial planning strategy. Once again, the most visible way in which this took place was in the legal field. Freitas do Amaral (1941–2019), lawyer, politician and university professor, pioneered in 1971 research on Urban Planning Law,8 along with José Osvaldo Gomes and Fernando Alves Correia both among Portugal’s first legal specialists in Urban Planning Law (Amaral, 1991, p. 92). Contradicting Ribeiro Telles’ intentions, Alves Correia claimed that Urban Planning Law should not be subordinated to Environmental Law being two distinct legal branches—though both were closely connected (Alves Correia, 1990, p. 85). Also, an interesting discussion taking place at this time was the one concerning the distinction between Urban Planning and Spatial Planning which was not at all clear. Freitas do Amaral argued that Urban Planning Law is subordinated to Spatial Planning Law because urbanism refers strictly to “urban agglomeration”. Alves Correia states that Spatial Planning Law stems from Urban Planning Law, and the latter has three levels: local, regional and national. To Freitas do Amaral, Urban Planning Law was always local (Amaral, 1991, pp. 9, 6). The discussion is significant to illustrate that not only there was a feeble spatial planning framework as at the highest level, pioneers of Spatial and Urban Planning Law were not in agreement concerning the scope, identity and definition of the object to be legislated. In 1990 (Decree n69/90, 2 March), anticipating the growing role of regional planning in the EU, a new decree established how current spatial 8 Freitas do Amaral held a PhD in Administrative Law, which is a branch of Public Law. Urban Planning Law is a branch of Administrative Law. In 1989 he edited a book on Urban Planning Law in an attempt to provide a state of the art (Amaral, 1989).

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planning instruments should articulate: Municipal Master Plan (Plano Director Municipal ), Urban Development Plan (Plano de Urbanização) and Site Plan (Plano de Pormenor). The 1990 decree also legally simplified procedures to approve Municipal Plans for Spatial Planning (broad scope plans, PMOT); however, these were elaborated having little or no articulation with the area’s economic development or other municipalities, prioritising the local level. At first, this decree seems to strengthen Freitas do Amaral legal perspective; however, this decree was not framed by a Spatial Planning Law. The closest to a Spatial Planning Law was Ribeiro Telles’ REN and RAN, prioritising rural and ecological elements. The legal strategy was to privilege the municipal level, which would generate a spatial planning that was diverse, representative and designed from the bottom up. But how did REN and RAN related to this decree? How to make sure that individual municipal strategies were jointly able to contribute to a spatial planning that was able to promote economic and social development? In the face of the new millennium and on the verge of a new European funding programme cycle (QCA III, 2000–2006), the Portuguese government admitted that national spatial planning legislation was scarce and ineffective. Two plans were agreed upon in order to support negotiations for QCA III: National Plan for Economic and Social Development (PNDES—Plano Nacional de Desenvolvimento Económico e Social) and Plan for Regional Development (PDR—Plano de Desenvolvimento Regional) (ADC, 2021). At urban level, some Portuguese cities were already involved in programmes like Urban Community Initiative (URBAN I 1994–1999 and URBAN II 2000–2006) (ECORYS, 2014, p. 2) that emphasised the role of innovation in tackling problems faced by urban areas and urban communities (EC, 2003). The Basic Law for Spatial and Urban Planning (LBOTU) issued in 1998 (Law n.48/98, 11 August; Decree n.380/99, 22 September) was a legislative initiative that intended to demonstrate Portugal’s willingness to apply a more pragmatic approach to spatial planning hoping this would facilitate implementation. (see Fig. 4.3) It aimed at articulating spatial planning at a national, regional and municipal level, creating a territorial management system comprised of 14 territorial management instruments (IGT): eight operating at a national and regional level and six at a municipal level. The law was perhaps too ambitious considering the deficiency of spatial planning implementation, but it had a significant novelty aiming

4 Territorial Development Legal Instruments

Sectoral Planning Legal Instruments Special Planning Legal Instruments

Territorial Planning Legal Instruments

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- National Program for Spatial Planning Policy -Regional Plan for Spatial Planning -Intermunicipal Plan for Spatial Planning - Sectoral Plans

National

- National Program for Spatial Planning Policy - Sectoral Plans - Special Plans for Spatial Planning

Regional

- Plans for Protected Areas Planning - Plans for Public Water Reservoirs - Plans for Coastal Area Planning - Municipal Master Plan - Urban Development Plan - Site Plan

Municipal

- Regional Plans for Spatial Planning -Intermunicipal Plan for Spatial Planning - Municiapl Plans for Spatial Planning

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Fig. 4.3 By the author. Spatial and Urban Planning legal instruments according to LBOTU, 1998. Based on Oliveira (2009, pp. 109, 110)

at articulating national, regional and municipal levels. Portugal’s traditional (modest) spatial planning system, since its beginning back in 1864, consistently privileged municipalities and the local level, always lacking an overarching national vision and a strategy to articulate all municipalities. Whichever was the distinction between spatial planning and urban planning; it was now time to move on. This new law would end all quarrels and start a new chapter. Nevertheless, at the time LBOTU was published, the departments that shared spatial planning competencies at government level confirmed both the system’s fragmentation and ambiguity on the matter: Minister for Infrastructure, Planning and Territorial Administration (João Cravinho); Secretary of State for Local Administration and Spatial Planning (José Augusto de Carvalho); High Commissioner of the Commission for Infrastructure and Territorial Administration Restructuring Support (Eduardo Cabrita); Director-general for Spatial Planning (João Biencard Cruz).9 (see Fig. 8). Also, in 1998, Prime Minister António Guterres presented a regionalisation referendum proposing the creation of eight regional authorities, each headed by a president and governed with the help of eight elected assemblies. The new regional authorities were to be given no legislative

9 For a detailed account of policy institutions and policy instruments at national, regional and local levels, see EC (2000).

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powers and had limited control over some expenditure in their regions (Corkill, 1999). The overall goal was to strengthen a mid-level that would be more effective in bridging local and national levels. The referendum had less than a 50% turnout, and around 63% voted “no”. Funded by QCA III, the first edition of programme POLIS— Programme for Urban Requalification and Environmental Enhancement of Cities (Programa de Requalificação Urbana e Valorização Ambiental das Cidades, 2000–2006) was officially launched (Resolução do Conselho de Ministros n.26/2000). This significant initiative aimed to foster urban rehabilitation through valuation and management of environmental and green structures. The fact that the document specifically articulated two different sectors was a novelty that should be praised in the Portuguese spatial policy context. Also, it was a positive feature that detailed specific actions to improve the surrounding environment at a local micro-scale making benefits very visible to those inhabiting the space (Moura, 2014). The programme was followed by POLIS XXI Cities (2007–2013). At this point, let us pause for a moment. By the end of the 1990s, several documents were all agreed upon without having an overarching framework: two plans detailing economic, social and regional development that supported QCA III (2000–2006) negotiations (in 1998 and 1999); POLIS (that favoured urban small-scale interventions); and the legislation LBOTU (1998) that aimed to facilitate and articulate local, regional and national implementation. But where was Portugal heading to, and what was the territory’s specific contribution to achieve economic, social and regional development? Was each region effectively contributing and aware of other regions’ contributions? Furthermore, what significant goals was the LBOTU articulating? Plans and legislation were being operationalised in a conceptual void, lacking intentionality. A First Attempt to Articulate an Institutional and Legal National Spatial Planning Strategy (PNPOT 2007–2017 and Basic Law for Soil, Spatial Planning and Urbanism Public Policies, 2014 and 2017) In 2007, a key document that designed a board scope national strategy for spatial planning was proclaimed: National Programme for Spatial Planning Policy (PNPOT—Programa Nacional da Política de Ordenamento do Território, Law 58/2007, 4 September; PNPOT, 2007). The document was in the making for 11 years, enduring five government mandates. PNPOT started taking shape in 1996, in 1998 was included in the

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LBOTU legislation, in 2002 the Ministers Council determined that the document’s specific guidelines should be elaborated, and in 2007, it was issued (Ferrão, 2019). It traced major guidelines that should orient public policies for the next ten years. PNPOT, a board strategic vision document, was issued after plans, programmes and legislations attempted to drive the operational level—with little success because they attempted to compensate for the lack of a main broad document (by being broad/vague) while failing to address highly relevant governance-related elements that at the end of the day are decisive to determine the success or demise of a strategy. Had it arrived too late? Would its orientations be able to put spatial and urban planning on track, working cohesively? Structural funding QREN (2007–2013) was in force during the 2008 financial crisis. Reinforcing the connection between macroeconomic policies and the relevance of territorial strategies, it is relevant to state that in its aftermath, between 2010 and 2014, Portugal had to request financial aid from the International Monetary Fund (IMF), the European Union (EU) and the European Central Bank (ECB). Having signed a memorandum in May 2011, several agreements were reached. Among them, one that compulsively implemented an aggregation of parishes (Reorganização Administrativa do Território das Freguesias —RATF) to reduce costs, create a more robust economy and increase the quality of services provided to citizens. This resulted in a decrease from 4,259 parishes to 3,092 (Ferreira, 2019).10 To prepare the programme Portugal 2020 (2014–2020), an evaluation of past initiatives was requested by DG REGIO to assess which strategy should Portugal pursue to achieve sustainable urban development. The study (ECORYS, 2014) included relevant national stakeholders, and results showed that “local socio-economic needs and challenges” were required to be addressed since the country’s spatial planning lacked focus (pp. 25–28). Also, it was necessary to promote integrated approaches “to urban development, with projects linking a wider range of themes 10 On this process and for a detailed analysis of the legal framework, see Oliveira et al. (2017). The authors had suggested that to revise this sudden change, a meticulous study should be conducted during one year, followed by public debate, also for one year, so that at least one year before legislative elections (in 2021), a renewed map and a clear mission of each parish was available (pp. 96–98). It has been recently announced that after the 2021 legislative elections, it is possible that the change will be reversed, replacing the new map for the old map (Anonymous, 2021). However, no study has been mentioned, and it is still uncertain on what grounds would that change take place.

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together” (pp. 20, 21) because there was no integrated or holistic strategy. Furthermore, it was crucial “to engage a diversity of public sector bodies (including different divisions within local authorities)”; “more stringent approaches to monitoring and evaluating the progress of project activities against their main objectives and key socio-economic challenges affecting the respective geographical areas” needed to be conducted and strategies to engage layers of government at both the supra-local and national levels needed to be designed (pp. 55–56). SMEs and local communities needed to be involved at a more specific operational level, and programmes focused on the smaller Portuguese urban centres and operating in deprived neighbourhoods in Lisbon and Oporto were needed. This evaluation clearly stated that when it came to spatial planning, much work remained to be done: defining a focus, promoting intersectoral strategies and multilevel governance mechanisms (vertical and horizontal), and to develop monitoring and evaluation approaches. What to do? Where to go from here? At the national level, two new policy instruments were created, the Basic Law for Soil, Spatial Planning and Urbanism Public Policies (Law n.31/2014, 30 May; Law n.74/2017) and the Regulatory Framework for Territorial Management Instruments (Decree n. 25/2021, 29 March, that updates Decree n.80/2015, 14 May and Decree n.380/99, 22 September). A detailed analysis is provided by Alves Correia (2014, 2018), Carvalho and Oliveira (2016) and Oliveira (2021). Still, one of the most interesting aspects was the law’s attempt to preserve rustic soil using two strategies: on the one hand, it restricted the definition of “urban soil” and expands the one of “rustic soil” (the use of “rural” is now replaced by “rustic”); on the other hand, it made it harder for municipalities to legally request for a soil to be classified as “urban”. The goal was to contain urban expansion, which was aligned with what was stated in PNOT, valuing the preservation of the environment (Carvalho & Oliveira, 2016, pp. 15, 18, 23). The new law also created several new instruments to support territorial management creating accountability for public (programas ) and public and private actors (planos ) at the national, regional and local levels. This resulted in an excessive configuration that, due to its complexity it was almost certain to negatively impact its efficacy (Carvalho & Oliveira, 2016, pp. 9, 10). Alves Correia (2014, p. 21) stated that it was always easier to change any given legislation than to promote a better context

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that allows for existing laws actually to work. Carvalho and Oliveira (2016, p. 9) argued that the answer was to change spatial planning culture by significantly reducing bureaucracy and propelling empowerment at the municipal level by facilitating new alternatives to make it more proactive. These would be the determinant factors for spatial and urban planning’s low efficacy. Towards a New Territorial Culture: Administrative Territories; PNPOT, 2020 (2020–2030); Governance Systems to Articulate National, Regional and Local Levels, Since 2017 To produce regional statistics, Eurostat set up the NUTS classification as a single, coherent system of the EU’s territory at the beginning of the 1970s. This classification worked informally until 2003, when it was regulated and actively implemented (Commission Regulation (EC) No 1059/2003; Eurostat, 2021). NUTS regions may change from time to time, but a stability of at least three years is assured. According to the most recent revision of NUTS, in 2021, Portugal’s NUTS 0 includes the country’s mainland territory and both sets of Atlantic islands, Azores and Madeira. NUTS 1 identifies these as three different regions. NUTS 2 distinguishes five continental regions. And NUTS 3 categorises twentythree statistical subregions of mainland Portugal and the 2 autonomous regions of the Azores and Madeira. Until 2016, two Local Administrative Units (LAU) levels existed, LAU level 1 and LAU level 2 (formerly NUTS level 4 and NUTS level 5, respectively). In Portugal, LAU 1 referred to municipalities and LAU 2 to parishes. Since 2017, only one level of LAU exists, and these are updated every year to be flexible and better address localities’ needs that may change regularly. In 2018, Eurostat launched a legislative initiative called “Tercet”, which integrates typologies into the NUTS regulation. At the regional level (NUTS 3), it identifies urban–rural typology; metropolitan typology; and coastal typology. At local level (LAU): degree of urbanisation (DEGURBA); functional urban areas; and coastal areas. Administration of the five regions in mainland Portugal (NUTS 2) is mainly performed by the Regional Coordination and Development Committees (CCDRs), which are decentralised bodies of central government with financial and administrative autonomy. NUTS 2 areas are entitled to implement their own regional operational programmes (ROPs).

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CCDRs were formally created in 1969 and overtime changed their structure, adapting to national interests. In 1986, with Portugal’s integration in the Community, CCDRs expanded its action to spatial planning, urbanism and environment policies instead of exclusively managing funds and promoting cooperation programmes. After its most recent update in 2012, CCDRs help manage European funds and provide technical support to municipalities, associations, parishes and citizens, promoting a sense of proximity between European and local development strategies (Decree 228/2012, 25 October; Decree 68/2014, 8 May and Decree 24/2015, 6 de February). (CCDR-LVT, 2021). Portugal has 308 municipalities represented by the municipal assembly (assemblies municipal ), deliberative and decision-making organ; and the municipal council (câmara municipal ), the municipality’s collegial executive organ, headed by the mayor (Presidente). There are 3 092 parishes, represented by the parish assembly (assembleia de freguesia), the deliberative body and the parish council (junta de freguesia), the executive organ. The parish’s chair (president) is a member of the municipal council within which the parish is located. All municipality representatives are elected for a four-year term (EP, 2019). When it comes to mandates, at the highest level, the country’s president has a five-year term, which can be renewed once. The prime minister has a four-year term, and there are no limits to the number of mandates. CCDRs’ leaders, municipalities and parishes’ representatives have a maximum of three four years mandates. According to these rules, in the upcoming 2021 elections, 38 municipality presidents’ will be unable to run. However, it is common for those who complete three mandates to run in a nearby municipality (Cunha, 2021). At the national level, setting an agenda for Portugal’s spatial planning, we have an updated revision of PNPOT in 2019, establishing the vision for the territory’s next 10 years. A careful investigation of PNPOT (2007) and PNPOT (2020) has led to identifying a common major critique related to governance: a lack of conceptual clarification of concepts (like “territorial cohesion”) that makes it hard to understand why is “territorial cooperation” only detailed at a trans-frontier and euro cities level but not at a national/internal level (Pires & Lange, 2019); and the need for a cultural turn operated by a culture change that encompasses government, planners, local government and citizens (Mourato, 2011, pp. 176, 177). Ferrão (2019) claims that PNPOT, 2020’s success depends on four

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key elements: the crucial role that spatial planning will play in the political agenda; the capacity to lead by those responsible for spatial and urban planning matters; the ability to create territorial and multilevel governance systems; the capacity to develop a spatial planning culture among citizens and public and private decision-makers. This means that it should not be expected that PNPOT solves all problems. Still, as an overarching document, it should be expected that all others reflect, articulate and detail its principles and, therefore, clarity and prioritisation and indispensable characteristics.

Conclusion (Tensions and Solutions) Cities are now identified as the vital element to promote “territorial cohesion”, confirming the increasingly predominant role of spatial planning in cohesion policy. When it comes to spatial and urban planning, different components can either harmonise or create conflict: a given economic model; political interests, political rhetoric and governance systems; nonbinding strategic documents (agenda-setting); legal framework and implementation. All these elements should work together towards a human-centred common goal, clearly identified, articulated by effective and efficient governance systems. The task is enormous and complex, demanding constant and renewed determination. Territory can either be perceived as the place where all these are reflected, or it can be perceived as the critical element that has the power to shape each of the components, making them work towards a common goal. The former represents a reactive approach to territory, and it is predominantly shaped by the past, the latter is a proactive approach, and it is designed to create the future. Progressively, in the context of the EU, cohesion policy is now urban. We went from a cohesion-regional policy to a cohesion-urban policy. This reflects an intention to scale down macro-structures to facilitate planning processes, which in other words could be said to aim at transferring placemaking from formal decisions to implementation. The recent goal of bringing spatial and urban planning together is to facilitate vertical multilevel governance creating a more effortless flow between EU institutions and member states, facilitating top-down and bottom-up strategies. The two most recent EU documents, the Territorial Agenda of the EU 2030 and New Leipzig Charter (2020), confirm this addressing,

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respectively, the macro and micro level: the idea of territorial cohesion combined with a place-based approach to creating a governance system that facilitates the translation of general spatial planning guidelines into on the ground strategic projects. In the context of the urban agenda, good governance is defined in the New Leipzig Charter as an urban policy for the common good that takes an integrated approach that promotes participation and co-creation, taking a multilevel governance and a place-based approach. Since its beginning, regional policy is a mechanism that is part of the EU’s political agenda perceived as vital to reducing inequalities among Member States. In Portugal’s governance system, the classification “region” has not been very significant. On paper, there have been several attempts to make it more relevant, bridging national and local levels. In practice, both levels remain somewhat disconnected. Two main reasons have contributed to this: 1. Horizontal governance mechanisms: Particularly after 1974, Portugal has systematically addressed spatial planning privileging the local (municipal ) level in an attempt to create, what could be said to be, a grassroots spatial planning strategy, bottom up. This almost sounds contemporary and ahead of its time since it seems to embody the EU’s current place-based cohesion strategy. Nevertheless, this territorial design corresponds to a phenomenon that Ferrão (2002) identified as “archipelagos”. Expanding this metaphor, Portugal’s territory is comprised of many archipelagos (municipalities), and each perceives other municipalities as competitors (adopting a selfsegregating attitude) lacking micro-scale governance mechanisms that allow them to effectively communicate and articulate initiatives with other municipalities. During Salazar’s government, before Portugal became a democratic government in 1974, one of the country’s mottos —that was a symbol of national courage to stand by its principles—was “Proudly alone” (Orgulhosamente sós ). This embodied decades of an isolationist and neutrality-based foreign policy that, on the one hand, avoided Portugal’s participation in World War II, offering refuge for many escaping the war and, on the other hand, contributed to a significant social and economic arrested development.

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It could be said that at the birth of its democracy in 1974, as much as Portugal wanted to be free of its past, the collective trauma of living under an authoritarian government over 40 years lived on, embodied in the country’s territory at a micro level and prevailed up until today in the “archipelagos” phenomenon under the motto “Proudly alone”. 2. Vertical governance mechanisms: Since Portugal became an EU Member State in 1986, as the role of regions to access structural funding increased, it has struggled to provide a satisfactory account of the use of its territory to promote social and economic development. Nevertheless, it was never clear which was the country’s overall development strategy and how the territory contributed to achieving it. Therefore, on the one hand, the country’s vertical governance system had a severe gap failing to connect national and local levels. Firstly, it had openly prioritised the local level for many decades. Secondly, when it later attempted to create a national spatial planning strategy, it did so, privileging binding instruments (legislative documents) instead of recurring to nonbinding instruments. These are helpful to achieve consensus and better assure a successful implementation of binding instruments. Yet, I would say that the option of going straight to binding instruments had two main reasons: first, decision-makers were aware of the difficulty to reach consensus due to the highly prevailing and strongly rooted “archipelagos” culture; second, in the context of the EU, decisionmakers needed to quickly produce documentation that proved the existence of a spatial planning strategy. However, let’s remind us that Portugal’s first broad scope spatial planning agenda-setting (nonbinding document) only came to exist in 2007 with PNPOT (11 years in the making). On the other hand, precisely because of Portugal’s inexistent vertical governance system and due to the need to have one that it could show to the EU, it has over time designed one that fits the rhetoric of EU (though comprised by sparse and fragmented documents). In Ferrão’s words, Portugal has designed its spatial planning strategy “from the outside, inwards” (Ferrão, 2010). Metaphorically, the priority has been assuring a vertical governance system from the EU inwards that stopped at Portugal’s border. This has generated a contradiction with complex consequences to evaluate: to create a strategic planning strategy (by definition, proactive, predictive, regional and place-based) Portugal

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has consistently issued documents that follow and match EU’s general guidelines creating a spatial planning strategy founded on reactive, retrospective, national and broad premises. Both the EU and Portugal need to harmonise and consistently articulate their institutional, policy and legal framework (Dühr et al., 2007). Just like the EU aims to be able to create effective mechanisms to articulate its national, regional and local territories, so does each Member State at the national level. At this point, I go back to Albrechts (1997) highly relevant question, more relevant today than before: is the EU’s territorial cohesion policy uniform aiming to create a planning system all over Europe or is it providing a framework where existing national planning systems remain intact? Portugal’s lack of internal territorial cohesiveness and frail national horizontal and vertical governance systems makes it highly permeable to inadvertently fit a potential EU territorial cohesion policy. (In the following pages, I will demonstrate that there is such a uniform planning system all over Europe.) Whether there is a uniform European planning system or not, Portugal’s weak vertical and horizontal governance system hinders the translation of both EU and national spatial planning strategies into strategic plans, leading to weak implementation. Decades-long of a spatial planning strategy lacking a solid governance system has been leaving Portugal’s territory adrift. How to go forward from here? As much as the EU’s spatial development should have cross-border and transnational dimensions, it should be acknowledged that some countries have a more robust internal resilience to reach out and form alliances with Member States than others. To a country with a weak internal spatial cohesiveness, cooperation may be perceived as a threat to its own survival instead of an opportunity to become stronger. In that sense, it is vital to design context-sensitive spatial policies. This recommendation applies to the macro EU level and also to Member State level. It is time for Portuguese decision-makers to give themselves permission to be more attentive to national context-specific elements when designing national, regional and local spatial and urban planning strategies, demonstrating

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a higher sense of agency. This is particularly relevant to countries more susceptible to shocks like Portugal, whose economy relies on volatile economic sectors like tourism. In that sense, the spatial impacts of economic specialisation and sectoral policies need to be more effectively assessed and coordinated at EU level. Furthermore, DG REGIO should monitor—ex-ante, during and ex-post —the results of interventions, using rigorous criteria preventing the possibility that greater complexity hinders flexibility in policy objectives (Farole et al., 2011). Several authors claim that is it essential that Portugal promotes a change in spatial planning culture, and this is vigorously confirmed by the updated 2019 version of PNPOT, 2020, Portugal’s agenda-setting document. Urban planning law specialists suggest that to make this change happen, bureaucracy should be significantly reduced, and empowerment should be promoted at the municipal level by facilitating new alternatives to make it more proactive. Can this contribute to dissipating the “archipelago” phenomenon? How to encourage a cultural turn where municipalities invert their decades-long self-segregation habit and where national policies identify and design national context-sensitive policies that clearly articulate how the use of territory contributes to the country’s economic, social and ecologically sustainable development? Carvalho (2016) identifies mobility, connectivity and ecology as elements that should be prioritised to orient Portugal’s spatial and urban planning strategy, contributing to lessening national asymmetries promoting growth beyond Lisbon (city capital) and coastal areas. This triad echo Ribeiro Telles’ 1970s strategy that puts ecology at centre stage. I suggest that a Portuguese context-sensitive-based strategy should be founded in connection with the land, which includes agricultural practices, and a holistic nature-based development, which includes maritime affairs, is the foundational principle that culturally reflects a national identity able to harmonise the territory. This approach could grant the cohesive aspect that would be able to propel cultural territorial change. These elements do not need to become predominant economic sectors, but they could be used to significantly contribute to propel and design strategies in other sectors. For example, it is known that agromanagement impacts soil carbon dynamics and soil quality being relevant to determine land use and positively contributing to pushing forward climate change (Srivastava et al., 2019).

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The following chapters address how health policies and spatial and urban policies intertwine and why governance systems and indicators can be helpful to jointly boost both areas.

References Anonymous. (1996). Towards a supranational spatial development perspective: Experience in Europe. Journal of Planning Education and Research, 15(2), 135–142. https://doi.org/10.1177/0739456X9601500206 Anonymous (2021, May 6). Regime para reverter freguesias agregadas em 2013 só deverá entrar em vigor após autárquicas. Jornal Observador. https://observador.pt/2021/05/06/regime-para-reverter-freguesiasagregadas-em-2013-so-devera-entrar-em-vigor-apos-autarquicas/ ADC. Agência para o Desenvolvimento & Coesão IP. (2021). Fundos da União Europeia—1986–1988, QCA I, II, III e QREN . https://www.adcoesao.pt/ content/1986-1988-qca-i-ii-iii-e-qren Adler-Nissen, R. (2014). Opting out of the European Union: Diplomacy, sovereignty and european integration. Cambridge University Press. Ahrend, R., Lembcke, A. C., & Schumann, A. (2017). The role of urban agglomerations for economic and productivity growth. International productivity monitor, 32, 161–179. https://EconPapers.repec.org/RePEc:sls:ipmsls:v:32: y:2017:9 Albrechts, L. (1997). Genesis of a Western European spatial policy? Journal of Planning Education and Research, 17 , 158–167. https://doi.org/10.1177/ 0739456X9701700206 Albrechts, L. (2006). Bridge the gap: From spatial planning to strategic projects. European Planning Studies, 14(10), 1487–1500. https://doi.org/10.1080/ 09654310600852464 Ali, T. M. (2012). The impact of the sovereign debt crisis on the Eurozone countries. Procedia—Social and Behavioral Sciences, 62, 424–430. https:// doi.org/10.1016/j.sbspro.2012.09.069 Alves, R. P. (2017). Portugal: A paradox in productivity. International Productivity Monitor, 32, 137–160. https://EconPapers.repec.org/RePEc:sls:ipmsls: v:32:y:2017:8 Alves Correia, F. (1990). O plano urbanístico e o princípio da igualdade. Almedina. Alves Correia, F. (2014). A nova lei de bases gerais da política de solos, de ordenamento do território e de urbanismo: Alguns princípios fundamentais. RevCedoua, 34, 9–21. Alves Correia, F. (2018). Evolução do Direito do Urbanismo em Portugal de 2012 a 2017. Cedoua 41, 9–25.

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Amaral, D. F. do (1989). Direito do urbanismo. Instituto Nacional de Administração. Amaral, D. F. do (1991). Apreciação da dissertação de doutoramento do licenciado Fernando Alves Correia : O plano urbanístico e o princípio da igualdade. Sep. de Revista da Faculdade de Direito. 91–105. Amaro Alves, R. M. (2007). Políticas de Planeamento e Ordenamento do Território no Estado Português. Fundação Calouste Gulbenkian. Arquivo Histórico (2021). Governos Constitucionais. Governo da República Portuguesa. https://www.historico.portugal.gov.pt/ Banque de France. (2012). Public debt, monetary policy and financial stability. Financial Stability Review, 16(April). https://abc-economie.banque-france. fr/sites/default/files/medias/documents/financial-stability-review-16_201204.pdf#page=109 Barreto, F. (2011) Contributo para a história da arquitectra paisagista em Portugal: Arquitecto paisagista António Facco Vianna Barreto [Master’s dissertation, Universidade Técnica de Lisboa]. UTL Repository. https://www.rep ository.utl.pt Callan, T., Leventi, C., Levy, H., Matsaganis, M. Paulus, A., & Sutherland, H. (2011). The distributional effects of austerity measures: A comparison of six EU countries. EUROMOD Working Paper, No. EM6/11. Institute for Social and Economic Research (ISER), University of Essex. http://hdl.handle.net/ 10419/64872 Carvalho, J., & Oliveira, F. P. (2016). Classificação, reclassificação e qualificação do solo no novo quadro legal. In J. Carvalho & F. P. Oliveira (Eds.), Classificação do solo no novo quadro legal (pp. 9–36). Almedina. CCDR-LVT. (2021). Breve historial CCDR. Comissão de Coordenação e Desenvolvimento Regional de Lisboa e Vale do Tejo Webite. http://www.ccdr-lvt.pt/ pt/breve-historial-ccdr/9595.htm Corkill, D. (1999). Portugal’s 1998 referendums. West European Politics, 22(2), 186–192. https://doi.org/10.1080/01402389908425308 Carvalho, J. (2016). Matriz estruturante de territórios urbanos emergentes. In J. Carvalho & F. P. Oliveira (Eds.), Classificação do solo no novo quadro legal (pp. 59–90). Almedina. Costa, L., Guedes de Oliveira, F., Leitão, A., & Paredes, J. (2021). Business cycles and trends in Germany and Portugal: Macroeconomic policy implications in the Euro Area. European Planning Studies, 29(4), 654–680. https:// doi.org/10.1080/09654313.2020.1766424 Council of Europe. (2021). Conference of Ministers responsible for Spatial/Regional Planning (CEMAT). Council of Europe Website. https:// www.coe.int/en/web/conference-ministers-spatial-planning/ministerial-con ferences

86

D. SOEIRO

Consilium. (2021). Infographic—Multiannual financial framework 2021–2027 and Next-Generation EU. European Council, Council of the European Union Website. https://www.consilium.europa.eu/en/infographics/mff2021-2027ngeu-final/ Cunha, M. L. (2021, April 21). Limitação de mandatos obriga 38 autarcas a deixar presidências de câmara. Observador. https://observador.pt/2021/ 04/21/limitacao-de-mandatos-obriga-38-autarcas-a-deixar-presidencias-decamara/ Dallhammer, E., Gaugitsch, R., Neugebauer, W., & Böhme, K. (2018). Spatial planning and governance within EU policies and legislation and their relevance to the New Urban Agenda. European Committee of the Regions—COTER. https://doi.org/10.2863/0251 Donald, B., Glasmeier, A., Gray, M., & Lobao, L. (2014). Austerity in the city: Economic crisis and urban service decline? Cambridge Journal of Regions, Economy and Society, 7 (1), 3–15. https://doi.org/10.1093/cjres/rst040 Dühr, S., Stead, D., & Zonneveld, W. (2007). The Europeanization of spatial planning through territorial cooperation. Planning Practice & Research, 22(3), 291–307. https://doi.org/10.1080/02697450701688245 EC. European Commission. (2000). The EU compendium of spatial planning systems and policies—Portugal. Regional Development Studies, Luxembourg: Office for Official Publications of the European Communities. CX-10-97817-EN-C. https://op.europa.eu/en/ EC. European Commission. (2003). Partnership with the cities: The URBAN community initiative. Directorate General—Regional Policy. https://ec.eur opa.eu/regional_policy/sources/docgener/presenta/cities/cities_en.pdf EC. European Commission. (2021). History of the [regional] policy. https://ec. europa.eu/regional_policy/en/policy/what/history/ EC-EG. European Commission-European Governance. (2001). A White Paper. Brussels, 25.7.2001. COM (2001) 42. https://ec.europa.eu/commission/ presscorner/detail/en/DOC_01_10 ECORYS. European Commission: DG Regional and Urban Policy. (2014). Sustainable urban development in Portugal: An integrated approach. Publications Office of the European Union. https://www.europeansources.info Elden, S. (2013). How should we do the history of territory? Territory, Politics, Governance, 1(1), 5–20. https://doi.org/10.1080/21622671.2012.733317 EP. European Parliament. (2019). Requested by the REGI committee. Economic, social and territorial situation of Portugal [Briefing]. https://www.europarl. europa.eu/RegData/etudes/BRIE/2019/629190/IPOL_BRI(2019)629 190_EN.pdf Eurostat. (2021). NUTS. https://ec.europa.eu/eurostat/web/nuts/ Fadigas, L. (2015). Urbanismo e Território. Edições Sílabo.

4

SPATIAL AND URBAN PLANNING

87

Faludi, A. (2021). European history and traditions: Revisiting the European spatial development perspective. In M. Neuman & W. Zonneveld (Eds.), The Routledge handbook of regional design (pp. 33–47). Taylor & Francis. https:// doi.org/10.4324/9780429290268-4 Farole, T., Rodríguez-Pose, A., & Storper, M. (2011). Cohesion policy in the European Union: Growth, geography, institutions. Journal of Common Market Studies, 49(5), 1089–1111. https://doi.org/10.1111/j.1468-5965. 2010.02161.x Ferrão, J. (2002). Portugal, três geografias em recombinação: Espacialidades, mapas cognitivos e identidades territorais. Lusotopie, 9(9), 151–158. Ferrão, J. (2010). Ordenamento do território: 25 anos de aprendizagem. Europa—Novas Fronteiras, 26/27 , 77–84. Ferrão, J. (2019). O Programa Nacional da Política de Ordenamento do Território: Da ideia à prática. Public Policy Portuguese Journal, 4(2), 7–11. Ferreira, A. (2019). A Implementação da Reorganização Administrativa do Território das Freguesias em Portugal nas Perspetiva dos Cidadãos [Master’s dissertation, Universidade de Coimbra]. UC Repository. http://hdl.handle. net/10316/85944 Fominaya, C. F. (2017). European anti-austerity and pro-democracy protests in the wake of the global financial crisis. Social Movement Studies, 16(1), 1–20. https://doi.org/10.1080/14742837.2016.1256193 Futurium. (2021). Urban agenda for the EU. What is the urban agenda for the EU? https://futurium.ec.europa.eu/en/urban-agenda/pages/whaturban-agenda-eu Geiger, N. (2015). The rise of behavioural economics: A quantitative assessment. [Research Paper] No. 44/2015, Universität Hohenheim, Stuttgart. http:// nbn-resolving.de/urn:nbn:de:bsz:100-opus-10845 Green Paper on Territorial Cohesion. (2009). CELEX number: 52009IP0163. https://eur-lex.europa.eu/ Hadjimichalis, C. (2011). Uneven geographical development and socio-spatial justice and solidarity: European regions after the 2009 financial crisis. European Urban and Regional Studies, 18(3), 254–274. https://doi.org/10. 1177/0969776411404873 Hahn, J. (Ed.) (2012). Cohesion Policy 2014–2020—Investing in Europe’s regions. Panorama—Inforegio, 40(Winter 2011/2012). https://ec.europa. eu/regional_policy/sources/docgener/panorama/pdf/mag40/mag40_en. pdf Healey, P. (2004). The treatment of space and place in the new strategic spatial planning in Europe. International Journal of Urban and Regional Research, 28(1), 45–67. https://doi.org/10.1111/j.0309-1317.2004.00502.x Interreg (2021). About us. Interreg Website. https://www.interregeurope.eu/ about-us/what-is-interreg-europe/

88

D. SOEIRO

Jackson, T. (2011). Prosperity without growth. Earthscan. Keating, M. (2008). Thirty years of territorial politics. West European Politics, 31(1–2), 60–81. https://doi.org/10.1080/01402380701833723 Lak, M. (2020). Europe and the European Union in times of growing scepticism. Journal of World History, 31(1), 236–250. https://doi.org/10.1353/ jwh.2020.0010 Meadows, D. H., Randers, J., & Meadows, D. L. (2004). Limits to growth: The 30-year update. Chelsea Green Publishing. Medeiros, E., & Rauhut, D. (2020). Territorial cohesion cities: A policy recipe for achieving territorial cohesion? Regional Studies, 54(1), 120–128. https:// doi.org/10.1080/00343404.2018.1548764 Mendes, L. (2012). De que se fala quando se fala de RAN e REN? [Master’s dissertation, Universidadte do Porto]. UP Repository. https://repositorio-abe rto.up.pt/ Midgley, J. (2014). Austerity versus stimulus: Theoretical perspectives and policy implications. The Journal of Sociology & Social Welfare, 41(2), 3. https://sch olarworks.wmich.edu/jssw/vol41/iss2/3 Mota, J. C. (2017). Participação dos cidadãos nos Instrumentos de Gestão Territorial. In F. P. Oliveira (Ed.), Ordenamento do território, urbanismo e cidades. Que rumo?, Volume I. Almedina. Moura, B. (2014). Programa POLIS: O caso da cidade da Covilhã [Master’s dissertation, Universidade da Beira Interior]. UBI Repository. https://ubibli orum.ubi.pt/bitstream/10400.6/4918/1/3897_7695.pdf Mourato, J. (2011). Europeanisation and territorial governance: An inquiry into power and institutional culture change in Portugal [Doctoral dissertation, University College of London]. UCL Repository. https://discovery.ucl.ac. uk/id/eprint/1334588/1/1334588.pdf NLC. New Leipzig Charter. (2020). Adopted at the Informal Ministerial Meeting on Urban Matters on 30 November 2020. EU2020.DE. European Commission Website. https://ec.europa.eu/regional_policy/sources/docgener/bro chure/new_leipzig_charter/new_leipzig_charter_en.pdf Oliveira, A. C. de, Oliveira, F. P., & Batalhão, C. J. (2017). As freguesias em Portugal. Que futuro?. AEDRL. Oliveira, F. P. (2009). Portugal: Território e ordenamento. Almedina. Oliveira, F. P. (2021). Breves Reflexões sobre a Alteração ao Regime Jurídico dos Instrumentos de Gestão Territorial: O decreto-lei N.º 25/2021 de 29 de Março. Almedina. Pazos-Vidal, S. (2019). Subsidiarity and EU multilevel governance: Actors, networks and agendas. Routledge. Pires, I., & Lange, E. (2019). O PNPOT e os processos de cooperação territorial em Portugal. Public Policy Portuguese Journal, 4(2), 52–67. http://hdl.han dle.net/10362/95071

4

SPATIAL AND URBAN PLANNING

89

PNPOT. (2007). Programa Nacional da Política do Ordenamento do Território (PNPOT). Direcção-Geral do Território. https://pnpot.dgterritorio.pt/ pnpot PNPOT 2020. (2019). Programa Nacional da Política do Ordenamento do Território (PNPOT). Lei n.o 99/2019 de 5 de setembro Diário da República n.o 170/2019. Direcção-Geral do Território. https://pnpot.dgterritorio.pt/ pnpot Rauhut, D., & Humer, A. (2020). EU cohesion policy and spatial economic growth: Trajectories in economic thought. European Planning Studies, 28(11), 2116–2133. https://doi.org/10.1080/09654313.2019.1709416 Roth, F., Nowak-Lehmann, D., Felicitas & Otter, T. (2011). Has the financial crisis shattered citizens’ trust in national and European governmental institutions? Evidence from the EU member states, 1999–2010. [Policy Brief] CEPS Papers 4159, Centre for European Policy Studies, Brussels. https://www.cep s.eu/ Scharpf, F. W. (2001). European governance: Common concerns vs the challenge of diversity [MPIfG Working Paper] No. 01/6, Max Planck Institute for the Study of Societies, Cologne. http://www.mpifg.de/pu/workpap/wp016/wp01-6.html Scharpf, F. W. (2006). Problem solving effectiveness and democratic accountability in the EU . Reihe Politikwissenschaft. Political Science Series 107. Institute for Advanced Studies, Vienna. http://aei.pitt.edu/6097/1/pw_107.pdf Schipper, S., & Schönig, B. (Eds.) (2016). Urban austerity: Impacts of the global financial crisis on cities in Europe. Theater der Zeit. Serricchio, F., Tsakatika, M., & Quaglia, L. (2013). Euroscepticism and the global financial crisis. Journal of Common Market Studies, 51(1), 51–64. https://doi.org/10.1111/j.1468-5965.2012.02299.x Soeiro, D. (2019). Gonçalo Ribeiro Telles, b.1922. In S. Ross (Ed.), Routledge Encyclopedia of Modernism. Routledge. https://doi.org/10.4324/978 1135000356-REM2082-1 Soja, E. W. (2010). Seeking spatial justice. Minnesota Press. Sokolska, I. (2021). The first treaties [Fact Sheets on the European Union]. European Parliament. https://www.europarl.europa.eu/factsheets/en/sheet/ 1/the-first-treaties Srivastava, P., Singh, R., Bhadouria, R., Tripathi, S., Singh, H., & Raghubanshi, A. S. (2019). Understanding soil aggregate dynamics and its relation with land use and climate change. In K. K. Choudhary, A. Kumar & A. K. Singh (Eds.), Climate change and agricultural ecosystems (pp. 331–354). Woodhead Publishing. https://doi.org/10.1016/B978-0-12-816483-9.00021-9

90

D. SOEIRO

TAEU 2030. (2020). Territorial Agenda for the European Union 2030 (1 December, Germany). Informal meeting of Ministers responsible for spatial planning, territorial development and/or territorial cohesion https://territori alagenda.eu/wp-content/uploads/TA2030_jun2021_en.pdf Theodore, N. (2020). Governing through austerity: (Il)logic of neoliberal urbanism after the global financial crisis. Journal of Urban Affairs, 42(1), 1–17. https://doi.org/10.1080/07352166.2019.1623683 Torreblanca, J. I., & Leonard, M. (2013). The continent-wide rise of euroscepticism [Policy memo]. European Council on Foreign Relations. http:// www.vervinomni.net/euroscepticism.pdf Treaty of Amsterdam. (1999). European Parliament. 2 October 1997. https:// www.europarl.europa.eu/about-parliament/en/in-the-past/the-parliamentand-the-treaties/treaty-of-amsterdam Treaty of Lisbon. (2009). European Parliament. 13 December 2007. https:// www.europarl.europa.eu/about-parliament/en/in-the-past/the-parliamentand-the-treaties/treaty-of-lisbon Treaty of Nice. (2003). European Parliament. 26 February 2001. https:// www.europarl.europa.eu/about-parliament/en/in-the-past/the-parliamentand-the-treaties/treaty-of-nice Treaty of Paris. (1951). European Parliament. 18 April 1951. https://www.eur oparl.europa.eu/about-parliament/en/in-the-past/the-parliament-and-thetreaties/treaty-of-paris Treaty of Rome. (1958). European Parliament. 25 March 1957. https://www. europarl.europa.eu/about-parliament/en/in-the-past/the-parliament-andthe-treaties/treaty-of-rome Treaty on European Union (TEU)/Maastricht Treaty. (1993). European Parliament. 7 February 1992. https://www.europarl.europa.eu/about-parliament/ en/in-the-past/the-parliament-and-the-treaties/maastricht-treaty URBACT. (2021). URBACT—Our partners. https://urbact.eu/our-partners

CHAPTER 5

Health and Urban Planning. Growing Convergence of Health and Spatial Planning Policies

In 2007, for the first time in history, the global urban population exceeded the global rural population (United Nations, 2018). Since then and in a forecast that extends until 2050, urban population is expected to rapidly increase, and rural population is expected to slightly decrease. Worldwide, urban population went from 43% (1990) to 55% (2018), and up until 2050, it will reach 68% showing an average annual growth rate of 1,9%.1 In Europe, among countries expected to have an urban population of 90% or above by 2050 are: Denmark (92%), Finland (90%), Iceland (96%), Norway (90%), Sweden (93%), United Kingdom (90%), Belgium (99%), Luxembourg (95%) and The Netherlands (97%). What impact does a high urban population have on health? According to Mercer’s (2019) Quality of Life City Index (Mercer, 2019), these countries feature at least one city ranking between the 8th and 41st. According to Karimi and Brazier (2016), the terms “health”, “health-related quality of life” (HRQoL) and “quality of life” (QoL) are too often used interchangeably which makes the case confusing. Nevertheless, in Mercer’s index, health care is one among several quality of life indicators.

1 Developing countries will be the ones contributing the most to the increase, with an average annual growth rate of 3,9%.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 D. Soeiro, Cities, Health and Wellbeing, Sustainable Urban Futures, https://doi.org/10.1007/978-3-030-89348-4_5

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Among European countries with the lowest urban population percentages are Republic of Moldova (57%), Bosnia and Herzegovina (65%), Slovakia (66%), Romania (67%), Serbia (69%), Slovenia (69%), Poland (70%), Croatia (71%) and Austria (71%). With the exception of Austria, in Mercer’s Quality of Life City Index, at least one city of these countries ranks between 74 and 156th place.2 In this selected group of countries, there seems to be a relation between a high forecasted urbanisation rate above 90% (where the average growth between 2018 and 2050 is low) and current high quality of life. Also, these countries are known to be among the wealthiest in Europe. Can this confirm that in the European context, cities should be acknowledged as a critical element to economic growth, also establishing that urban growth equals the quality of life? And again, does a high quality of life always reflect good health, perceived good health or access to a health system? In an attempt to provide a clarification of this matter, I go back to Mercer’s Index. This index uses as relevant criteria safety, education, hygiene, health care, culture, environment, recreation, political-economic stability, public transport and access to goods and services. Using a mix of economic, social and ecological criteria does not allow for a specific account of the health realm. Let us, therefore, consider some data from OECD Better Life Index that is country-wide and contains other criteria to better assess the link between urban population, quality of life and health.3 From several criteria available, I selected the ones related to “community and civic engagement” to assess the strength of social networks, which is usually relevant for mental health and also “environment”, “health” and “life satisfaction” criteria. In Fig. 5.1, we can observe that air pollution is better in countries with higher rates of urban population. In general, countries that range among the ones with a lower urban population forecast (Slovak Republic, Slovenia and Poland) present a current lower quality of life, showing a high stakeholder engagement but a low voter turnout and a lower 2 Austria, according to Mercer, features Vienna as the number one city in the world with the Highest Quality of Life, having an expected urban population of 71% by 2050, which would make an interesting case study. 3 Data in OECD Better Life Index was only available to some of the countries mentioned above.

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Fig. 5.1 OECD (2021). Better life index. Accessed August 30, 2021. https:// stats.oecd.org/Index.aspx?DataSetCode=BLI#

life satisfaction—than countries where urban population above 90% is expected by 2050. In 2018, Portugal had 65% of its population living in urban areas, and by 2050 the number is expected to rise to 79%. According to Mercer, Portugal’s city capital, Lisbon, ranks 37th in the 2019 Quality of Life Index. Ranking average in basic community and environment assessment indicators, the population shows little stakeholder engagement and low voter turnout, scoring the lowest in self-reported health and life satisfaction. Therefore, the country is not a straightforward case that allows us to determine that in the European context, cities should be acknowledged as a critical element to economic growth, establishing that urban growth equals the quality of life. In other words, economic growth is not equal to social well-being and prosperity. Nevertheless, in Europe, it seems possible to state that countries with high urban population levels show high environmental performance. The European Green Deal aiming at becoming the first continent to fully decarbonise by 2050 confirms Europe’s high ambitions and leading role in the environmental area. In the aftermath of this brief analysis crossing information from three different sources (UN, Mercer and OECD), I would argue that from a spatial planning perspective, it is important to keep in mind that though the population residing in cities is expected to increase, each country

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has several cities of different dimensions. Therefore, it is vital to accurately identify urban, non-urban and transition areas, designing strategies to connect and balance them according to clearly identified priorities. Some of the current non-urban areas can be converted into future urban areas and, in a climate change scenario, vice-versa (especially in coastal areas). Flexibility and openness to change are critical in an increasingly unpredictable environment. Concerning urban areas, ultimately, I argue that to successfully design cities that show high economic, social and ecological performance, what is at stake is the quality of cities. Cities do not need to continue to be perceived as elements that hinder health. The focus should be on how to promote better quality cities and redefine what a city is. Whichever new models we come up with, health is the principal element that defines quality in urban environments. Key questions concerning both physical and mental health are: (1) physical health: are cities environmentally safe and are they resilient in the face of climate change; (2) mental health: do cities promote a good quality of life and are they restorative cities. Health is the ultimate success element that allows for economic, social and ecological accomplishment. Either small, medium or large cities, these should articulate with non-urban areas and, in particular pay attention to transition areas and connectivity matters, creating a flow and sense of continuity. Cities should increasingly incorporate more non-urban elements exploring different ways of connecting inhabitants with nature going beyond leisurely green spaces. This includes incorporating dynamic elements in space that allow for first-hand interaction with natural elements like farming, gardening and animal husbandry. These are the cities we should imagine, design and implement. In that sense, I argue that not only it is much needed, as it is highly expected that intersectoral policies addressing spatial and urban planning and health will increase. Furthermore, there is significant scientific evidence that confirms this, which I will now briefly review. According to Abbott (2012), epidemiologists were the first ones to show, decades ago, that people raised in cities are more prone to mental disorders than those raised in the countryside. In the 1930s, Faris and Dunham (1939) associated a higher risk of schizophrenia in urban areas, which was more recently confirmed by Lewis et al. (1992), Mortensen et al. (1999) and Pedersen and Mortensen (2001). Vassos et al. (2002) demonstrated that risk for schizophrenia (and nonaffective psychosis)

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doubles in urban environments. A large study conducted in The Netherlands between 1942 and 1978 (Marcelis et al., 1998) concluded that not only there are higher rates of psychosis in urban areas as the effect of environmental factors associated with urbanisation appears to increase over successive generations. Neuroscientists only started studying the connection between cities and mental disorders more recently. A groundbreaking study by Lederbogen et al. (2011) validates that it is possible to identify distinct neural mechanisms for an established environmental risk factor, linking the urban environment for the first time to social stress processing. Since then, countless studies have confirmed that urban nature is favourable to public health and psychological well-being, and scientific evidence has been rapidly expanding (Dobson et al., 2021; Jaffe, 2015; Jennings & Bamkole, 2019). Urban nature can strongly impact urban design, and it has been demonstrated, for example, how green façades can contribute to stress recovery and well-being in high-density cities (Elsadek et al., 2019) or how the practice of organic farming can have positive implications for mental health (Brigance et al., 2018) favouring the implementation of farming in urban settings. In a key study accounting for the impact of elements of stress in the surrounding environment, Ulrich et al. (1991) concluded that not only settings that have extreme or unusual properties, such as loud noise or extreme temperatures, have a high-stress impact but also very common environments that most urbanites encounter daily in developed nations (like urban traffic; see also Chatterjee et al., 2020). More broadly, contact with nature positively supports young people’s mental health and well-being (Birch et al., 2020), as it does simply take a walk in a forest (Song et al., 2019). In a recent study, Cianconi et al. (2020) have highlighted the impact of climate change on mental health, connecting what I argue to be the two most relevant challenges in the upcoming decades. Psycho-physical symptoms can worsen as a consequence of climatic changes, like for example, mood disturbances, irritability, anxiety, mental and physical weakness, hypertension, headache, hyperalgesia and pains and autonomic symptoms; air pollution can induce neural instability; and scarce rain and low average temperature have been found to lead to psychiatric visits in emergency departments. Despite its complexity, climate change is known to have consequences on mental health. Urban parks (green areas, fitness equipment, jogging tracks, sports courts and other types of parks, Cranz &

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Boland, 2004) can be a solution to Mitigate Urban Heat Islands and promote thermal comfort (Bernard et al., 2018). Usually, health is primarily assessed in spatial and urban planning documents. Still, recently, the EU4Health Public Health Programme represents a very significant shift that demonstrates that it is time for Member States to be more proactive in promoting intersectoral policies, benefiting health. Though there were many available signals that the connection needed to occur, the pandemic accelerated the process. The Programme explicitly acknowledges the importance of mental health within health and explicitly calls for a change in public policies in promoting intersectoral strategies that promote health (see Chapter 3). Facing the urgent global need for accessible and cost-effective promental health infrastructure Giles-Corti et al. (2016) and Barton and Rogerson (2017) advocate for the importance of nature, greenspace and slow mobility infrastructures in urban planning as public policy. Let us remind ourselves that the estimated total costs of mental health problems amount to more than 4% of GDP across EU countries, over EUR 600 billion per year (OECD/EU, 2018). Spatial and urban planning strategies have the ability to contribute to reducing these costs. Scientific evidence showing a positive correlation between nature and mental health should serve as an incentive to push forward urban planning and urban design tools that actively contribute to promoting populationlevel mental health. This will inevitably lead to the need to conceive, design and implement intersectoral strategies that connect spatial and urban planning and health. The scientific evidence is at this point overwhelming, and it should be taken as an incentive in public policy but are agenda-setting documents and governance systems ready to embrace this connection and make the most of it?

References Abbott, A. (2012). Stress and the city: Urban decay. Nature, 490, 162–164 (11 October). https://doi.org/10.1038/490162a Barton, J., & Rogerson, M. (2017). The importance of greenspace for mental health. Bjpsych. International, 14(4), 79–81. https://doi.org/10.1192/S20 56474000002051 Bernard, J., Rodler, A., Morille, B., & Zhang, X. (2018). How to design a park and its surrounding urban morphology to optimize the spreading of cool air? Climate, 6(1). https://doi.org/10.3390/cli6010010

5

HEALTH AND URBAN PLANNING. GROWING CONVERGENCE …

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Birch, J., Rishbeth, C., & Payne, S. R. (2020). Nature doesn’t judge you— How urban nature supports young people’s mental health and well-being in a diverse UK city. Health & Place, 62, 102296. https://doi.org/10.1016/j. healthplace.2020.102296 Brigance, C., Soto Mas, F., Sanchez, V., & Handal, A. J. (2018). The mental health of the organic farmer: Psychosocial and contextual actors. Workplace Health & Safety, 66(12), 606–616. https://doi.org/10.1177/216507991 8783211 Chatterjee, K., Chng, S., Clark, B., Davis, A., De Vos, J., Ettema, D., Handy, S., Martin, A., & Reardon, L. (2020). Commuting and well-being: A critical overview of the literature with implications for policy and future research. Transport Reviews, 40(1), 5–34. https://doi.org/10.1080/01441647.2019. 1649317 Cianconi, P., Betrò, S., & Janiri, L. (2020). The impact of climate change on mental health: A systematic descriptive review. Front. Psychiatry. https://doi. org/10.3389/fpsyt.2020.00074 Cranz, G., & Boland, M. (2004). Defining the sustainable park: A fifth model for urban parks. Landscape Journal, 23(2), 102–120. http://www.jstor.org/ stable/43323666 Dobson, J., Birch, J., Brindley, P., Henneberry, J., McEwan, K., Mears, M., Richardson, M., & Jorgensen, A. (2021). The magic of the mundane: The vulnerable web of connections between urban nature and well-being. Cities, 108,102989. https://doi.org/10.1016/j.cities.2020.102989 Elsadek, M., Liu, B. & Lian, Z. (2019). Green façades: Their contribution to stress recovery and well-being in high-density cities. Urban Forestry & Urban Greening, 46, 126446. https://doi.org/10.1016/j.ufug.2019.126446 Faris, R. E. L., & Dunham, H. W. (1939). Mental disorders in urban areas: An ecological study of schizophrenia and other psychoses. University of Chicago Press. Giles-Corti, B., Vernez-Moudon, A., Reis, R., Turrell, G., Dannenberg, A.L., Badland, H., Foster, S., Lowe, M., Sallis, J.F., Stevenson, M. & Owen, N. (2016). City planning and population health: a global challenge. The Lancet, 6736(16), 30066. https://doi.org/10.1016/S0140-6736(16)30066-6 Jaffe, E. (2015, October 20). The (Pretty much totally) complete health case for urban nature: An annotated, chart-filled look at scientific evidence. The Atlantic Citylab. https://www.citylab.com/environment/2015/10/the-pre tty-much-totally-complete-health-case-for-urban-nature/411331/ Jennings, V., & Bamkole, O. (2019). The relationship between social cohesion and urban green space: An avenue for health promotion. International Journal of Environmental Research and Public Health, 16(3), 452. https:// doi.org/10.3390/ijerph16030452

98

D. SOEIRO

Karimi, M., & Brazier, J. (2016). Health, health-related quality of life, and quality of life: What is the difference? PharmacoEconomics, 34(7), 645–649. https://doi.org/10.1007/s40273-016-0389-9 PMID: 26892973. Lederbogen, F., Kirsch, P., Haddad, L., Streit, F., Tost, H., Schuch, P., Wüst, S., et al. (2011). City living and urban upbringing affect neural social stress processing in humans. Nature, 474, 498–501. https://doi.org/10.1038/nat ure10190 Lewis, G., David, A., Andréassson, S., & Allebeck, P. (1992). Schizophrenia and city life. The Lancet, 340(8812), 137–140. https://doi.org/10.1016/01406736(92)93213-7 Marcelis, M., Navarro-Mateu, F., Murray, R., Selten, J. P., & Van Os, J. (1998). Urbanization and psychosis: A study of 1942–1978 birth cohorts in The Netherlands. Psychological Medicine, 28(4), 871–879. https://doi.org/10. 1017/s0033291798006898 Mercer. (2019). Mobility, insights, quality of living ranking. https://mobilitye xchange.mercer.com/insights/quality-of-living-rankings Mortensen, P. B., Pedersen, C. B., Westergaard, T., Wohlfahrt, J., Ewald, H., Mors, O., Andersen, P. K., & Melbye, M. (1999). Effects of family history and place and season of birth on the risk of Schizophrenia. New England Journal of Medicine, 340, 603–608. https://doi.org/10.1056/NEJM19990 2253400803 Pedersen, C. B., & Mortensen, P. B. (2001). Evidence of a dose-response relationship between urbanicity during upbringing and Schizophrenia risk. Archives of General Psychiatry, 58(11), 1039–1046. https://doi.org/10. 1001/archpsyc.58.11.1039 OECD/EU. (2018). Health at a glance: Europe 2018: State of health in the EU cycle. OECD Publishing. https://doi.org/10.1787/health_glance_eur2018-en Song, C., Ikei, H., Kagawa, T., & Miyazaki, Y. (2019). Effects of walking in a forest on young women. International Journal of Environmental Research and Public Health, 16(29, 229. https://doi.org/10.3390/ijerph16020229 Ulrich, R. S., Simons, R. F., Losito, B. D., Fiorito, E., Miles, M. A., & Zelson, M. (1991). Stress recovery during exposure to natural and urban environments. Journal of Environmental Psychology, 11(3), 201–230. https://doi. org/10.1016/S0272-4944(05)80184-7 United Nations. (2018). World urbanization prospects: The 2018 revision, highlights (ST/ESA/SER.A/421). Department of Economic and Social Affairs, Population Division. https://population.un.org/wup/Publications/ Files/WUP2018-Highlights.pdf Vassos, E., Pedersen, C. B., Murray, R. M., Collier, D. A., & Lewis, C. M. (2002). Meta-analysis of the association of urbanicity with schizophrenia. Schizophrenia Bulletin, 38(6), 1118–1123. https://doi.org/10.1093/sch bul/sbs096

PART II

Policy Coordination and Intersectoral Action

CHAPTER 6

Introduction. Increasing Role of Joint Health and Spatial and Urban Planning Policies

Spatial and Urban Planning as a Vaccine. The Case of the COVID-19 Pandemic At the end of December 2019, an alert from China was broadcasted concerning a new virus in the Hubei Province that caused mysterious pneumonia-like symptoms showing high resistance to any kind of treatment (Li et al., 2020). In early January 2020, the World Health Organization (WHO) reported that Chinese authorities had identified a completely novel coronavirus. That same month, the virus was known to have reached several European countries. Italy was particularly hardhit in the first stages, becoming a hotspot (Berardi et al., 2020). On 11 March 2020, the virus had widely spread worldwide and WHO classified the occurrence as a pandemic (WHO, 2020). Since then, we have been experiencing what is known to be the first global pandemic in a context of globalisation characterised by high mobility, bringing uncharted complexity concerning spreading patterns and unprecedented management challenges. The immediate and shortterm impact across many areas and sectors were intense, leading to disruption in global food and medicine supply, education system, work mode, travel, tourism and hospitality industry and many others. The world population went into hiding, rapidly entering a synchronised survival mode, leaving businesses, cities, highways and public spaces empty. To assess the effect of such an unprecedented event in the short, medium and long © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 D. Soeiro, Cities, Health and Wellbeing, Sustainable Urban Futures, https://doi.org/10.1007/978-3-030-89348-4_6

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term is much needed across many different areas. But to reflect and investigate it properly, we need to be at a safe distance. Are we there yet? In mid-August 2021, it is still uncertain at what point of the pandemic are we. Is the end in sight? Quoting Sasse (2021, pp. 10, 20), who recently published a study on the long-term impact of COVID-19: we are “flying blind”, and the pandemic is far from over. Vaccination in the Global North has been rolling out (with several countries going beyond 60% vaccinated), and lockdowns in many countries have been eased. However, the Global South has been at the peak of impact, and vaccination inequality made these countries highly vulnerable to new variants that, over time, become more aggressive (Padma, 2021).1 Additionally, the possibility of getting these under control becomes more challenging in the Global South since there is limited ability to track the transmission of viral evolution. Vaccine distribution, genomic surveillance and outbreak management are the three main elements to tackle the pandemic in the long term. As Sasse claims: “Countries will need to continue to retain the ability to implement distancing and hygiene measures, and control outbreaks through border quarantine, while testing and local restrictions will remain critical for a long time to come. This will require both government capacity and public support” (Sasse, 2021, p. 12). Global health care has suffered from years of under-investment, which has left the world vulnerable to pandemics such as this one. Therefore, improvements in health care infrastructure, surveillance and global data sharing are much needed. It is essential to create new alternatives for building resilience (Sasse, 2021, pp. 16, 17). As it was stated in the previous chapter, addressing health through spatial and urban planning always was highly relevant, even before the 2020 pandemic, not only because carefully designed strategies can positively impact (public and individual) health as they can be a way of indirectly financing the health system, potentially cutting some costs and alleviating the burden on the National Health Service. The ongoing pandemic reinforces that strategic spatial and urban planning is a powerful tool to help build resilience in public health crises, environmental crisis and individual physical and mental health. 1 Hundreds of “variants of interest” are being tracked at any one time; these are upgraded to “variants of concern” or “high consequence” based on the threat they pose. Centre for Disease Control and Prevention (2021).

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In a 2017 Ted Talk, presenting her latest book, The Village Effect (Pinker, 2015), developmental psychologist Susan Pinker (2017) stated: “Face-to-face contact releases a whole cascade of neurotransmitters, and like a vaccine, they protect you now in the present and well into the future”. From a Psychology standpoint, she adds: “real social contact is a biological need like eating, drinking or sleeping. And our bodies react to the loss of that interaction the way we react to hunger. It’s physically painful. It’s damaging. It’s even dangerous long term”. Face-to-face interaction and real social contact are like a vaccine. Under a lockdown situation with added social contact restrictions enforced due to lack of a vaccine, what we are lacking is not only one but two different types of vaccine. Though one is widely available, we are forced to renounce the only one we have while waiting for the other, ending up with none. The argument for being so is valid since if we take the social connection vaccine, we may fall seriously ill, becoming a matter of life and death. That should be taken seriously. The question is, why is it that policy-wise, eating, drinking and sleeping are perceived as a collective biological need that needs to be addressed, and social contact is a need that each one individually needs to repress? The need to physically survive continuing to ensure basic needs like eating, drinking and sleeping were tackled by general public policies. However, these were achieved at the expense of enforcing and encouraging the self-imposition of social contact deprivation, implementing close to zero strategies to lessen its impact, though this is scientifically acknowledged as “physically painful, damaging and dangerous long term”. The pandemic unequivocally proved the importance of social interaction. Up to which extent its reduction impacted physical and mental health and an assessment of the effectiveness of the strategy medium and long term, remains to be seen. Hopefully, different scientific areas will catch up on this research in upcoming years. In July 2021, the European Parliament has issued a briefing on mental health and the pandemic, showing the first signs that the population’s increased psychosocial needs have to be addressed (Scholz, 2021). The Health at a Glance Europe 2020 report notes that the COVID-19 pandemic and the subsequent economic crisis caused a growing burden on the mental well-being of the citizens, with evidence of higher rates of stress, anxiety and depression. Young people and people in lowerincome groups are being considered at increased risk. Also, disruptions

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to health care for those with pre-existing mental health conditions constitute a significant part of the negative impact that the pandemic had on mental health (OECD/EU, 2018).2 Public space has the ability to promote and motivate better social integration. This includes weak bonds that Pinker (2017) claims should not be disregarded. Creating spaces, using spatial and urban planning, to encourage social integration and deepen weak bonds or close relationships is thus an opportunity that should not be missed being able to provide added resilience in times of crisis. Citing research conducted at Brigham Young University (Utah, USA) headed by Julianne Holt-Lunstad, Pinker states that it was concluded that among different aspects of people’s lifestyles that contributed to a longer life (from most to least relevant) are: social integration, close relationships, quit smoking, quit boozing, flu vaccine, cardiac rehab, exercise, lean vs overweight, hypertension Rx and clean air. Social connection ranks the top two. It is highly expected that intersectoral policies addressing spatial and urban planning, and health will increase. How to facilitate the path for this to happen institutionally and at governance level?

Mapping Impact: Health, and Spatial and Urban Planning Policies Leading EU agenda-setting documents concerning spatial and urban planning are Territorial Agenda 2030 (TAEU 2030) and the New Leipzig Charter (NLC, 2020). Do they address health concerns? When it comes to TAEU 2030, health is mentioned in its preamble twice, once acknowledging it as one of the elements contributing to promoting quality of life and lastly to justify the need to promote air, soil and water quality. Further ahead in the document, it dedicates a section to “healthy environments”, defining as priorities three major areas: ecosystems, climate

2 Significant resources at the EU level are the EU Health Policy Platform (European

Commission; https://webgate.ec.europa.eu/hpf/), an interactive tool to boost discussions about public health concerns, share knowledge and best practices; and Mental Health Europe (https://www.mhe-sme.org/), a European non-governmental network organisation, working closely with European Institutions, committed to the promotion of positive mental health.

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change, natural and cultural heritage. In all three, spatial and urban planning is directly appointed as an element that should be used to promote these. It argues for “nature-based solutions as well as green and blue infrastructure networks that link ecosystems and protected areas in spatial planning, land management and other policies, and the development of new crisis management tools to increase places’ safety and resilience” (TAEU 2030, 2021, p. 19). Particularly relevant in this statement are both green and blue infrastructure. Blue infrastructure refers to water elements like rivers, canals, ponds, etc., and green infrastructure refers to trees, lawns, parks, forests, etc. This relates with a previous EU document that is important to highlight, the Green Infrastructure Strategy—Enhancing Europe’s Natural Capital launched by the European Commission (2013), encouraging ecological, economic and social benefits through natural solutions.3 It acknowledges that nature’s value “is not fully appreciated [resulting] in public authorities turning to built infrastructure — grey infrastructure — as a substitute for natural solutions to problems such as flood prevention”. It warns that if we continue to have this approach, we degrade “our natural capital, jeopardising our long-term sustainability and undermining our resilience to environmental shocks” instead of boosting disaster resilience. This means that the true scope of TAEU 2030 concerning health environments is only grasped by going back to the principles stated in the 2013 Green Infrastructure Strategy.4 This is relevant to understand that the overarching framework of territorial cohesion in the EU is not the built environment but nature, defined

3 This was complemented by the report “Green infrastructure and territorial cohesion” (EC, 2011) and the EU 2020 Biodiversity Strategy. More updated information is at the European Environment Agency’s website. 4 The official Territorial Agenda (2021) website acknowledges as reference “recent developments described in various reports by the European Commission, the European Committee of the Regions, the European Investment Bank and ESPN. It takes into account main current policy frameworks and agendas, including the United Nations’ 2030 Agenda for Sustainable Development and the Sustainable Development Goals (2015), the Paris Agreement (2015), the United Nations’ New Urban Agenda (2016), the European Commission’s reflection paper ‘Towards a Sustainable Europe by 2030’ (2019), the proposal for the future of Cohesion Policy (2019), the Urban Agenda for the EU (2016), the revised Leipzig Charter (2020), the Cork 2.0 Declaration on a Better Life in Rural Areas (2016), the OECD’s Principles on Urban Policy and on Rural Policy (2019) and the European Green Deal (2019)”.

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as ecosystems under green and blue infrastructure networks—both in spatial and urban planning. Green and blue infrastructure should articulate with and ultimately prevail over grey infrastructure solutions. Quoting the Strategy, “[n]atural and cultural heritage are parts of the EU’s territorial capital and identity”, which is particularly relevant to spatial planning strategies. Also, “green infrastructure solutions are particularly important in urban environments” to deliver health-related benefits, and helping combat social exclusion and isolation. Health is also addressed in TAEU (2030) in the section “Sustainable digital and physical connectivity of places”, arguing that a sustainable digital society can support decentralised and sustainable developments as long as its infrastructure has a low carbon footprint and low impact on human health. At the urban planning level, the “New Leipzig Charter - The transformative power of cities for the common good” adopted in 2020 provides a key policy framework document for sustainable urban development in Europe. It clearly identifies a connection between urban planning, design and health, claiming that “[g]ood urban planning and design should be reinforced to enable compact, socially and economically mixed cities with well-developed infrastructure and a healthy environment and opportunities for identification contributing to the well-being of all” (p. 2). Furthermore, “cities and urban systems need flexibility as well as the ability to respond to external disruptive events and chronic stress”. Along the document, we find three main recommendations to make this happen: 1. To adopt a holistic understanding of high-quality Baukultur as the basis of integrated planning and design processes for every manmade shaping of the built environment in European cities; 2. To favour predictive and preventive policies, plans and projects that should include diverse scenarios to anticipate environmental and climatic challenges and economic risks as well as social transformation and health concern; 3. To use nature-based solutions that support the protection and regeneration of endangered ecosystems and their species, where high-quality green and blue infrastructure can accommodate extreme weather conditions. Well-designed, managed and connected

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green and blue areas are a precondition for healthy living environments, adapting to climate change and preserving and developing biodiversity in cities. Attesting its alignment with TAEU 2030, the New Leipzig Charter confirms that the framework which orients any spatial and urban planning policy, plan and project should be nature-based. The New Leipzig Charter also mentions equal access to health care (among other services and infrastructures) as an essential element of cities across Europe. This can be facilitated or hindered by urban planning decisions, and it is therefore positive that not only health but access to health care is addressed. Can the strategy designed in the TAEU 2030 and the New Leipzig Charter aiming at accomplishing a cohesion policy that privileges the role of cities finally reduce inequalities among the EU? How is regional policy still relevant in this context? Have urban policies fully replaced regional policies turning them obsolete to EU’s cohesion policy? To answer these questions, we need to assess what is the current perceived role of non-urban areas in the EU. A recent study requested by the European Parliament’s Committee on Regional Development (REGI Committee) on EU cohesion policy in non-urban areas (Kah et al., 2020) is helpful because it is very realistic in its state of the art. The study states that “there is no ‘one size fits all approach for rural areas”, adding that “[p]olicy needs to deal with the unique combinations of structural, social and geographic characteristics, and therefore requires tailored place-based approaches” (pp. 64, 65)—which is also true of urban areas. Among several recommendations, we find one that directly addresses governance. Local institutional capacity and local governance are important, but they need to be enhanced across governance scales. To mitigate this, authors call for consistent and simultaneous commitment of multiple governance levels. Aligned with this, it is required to strengthening urban–rural, interregional and international interactions. This implies solving the lack of infrastructures addressing concrete rural needs like broadband coverage (digitalisation area) and in terms of health care infrastructure. Another highly relevant recommendation that was previously stated in Chapter 3, is the need to have a national strategy and a general aim that is able to guide and articulate all other national policies. This is phrased in the study as the need to move from a “passive” logic to a more “active”

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one where a place-based approach that values specific local characteristics is complementary to larger development strategies, implemented at the regional and national level. According to the authors, this implies strengthening a “territorial view” instead of a “land-use view”. This, along with a multilevel governance strategy, would allow us to overcome where we stand now, in a state of “disconnection between the development of rural areas and regional policy implementation” (p. 65). Is it possible to assume this statement as an admission that regional policy failed in developing rural areas? Yes. But that does not mean that there isn’t a solution to go around it: to adopt a “territorial view” over a “land-use view” and to strengthen multilevel governance, strengthening urban–rural, interregional and transnational interactions. Both suggestions could easily be used as essential recommendations to cities in how to successfully perform their role in regional development. The same study (Kah et al., 2020) highlights that two of the most pressing strategies to develop non-urban areas are a more articulated strategy between cohesion policy and common agricultural policy, which includes EU’s Rural Development Policy (RDP) and additional funding for healthcare infrastructures and services in rural areas. What seems to be at stake is that though regional policy has affirmed cities and urban areas as its epicentre in recent years, its growth strategy needs to be exogenous, integrating and connecting with non-urban areas. Just like non-urban areas need to open up and embrace flexibility expanding their institutional ecosystem. In the aftermath of the COVID-19 pandemic, many decided to leave the city and move to smaller cities or to the countryside, and rural areas gained momentum. This is attested in a recent document issued by the European Commission (EC, 2021) in July that explicitly quotes the pandemic as one of its drivers, titled: A long-term vision for the EU’s Rural Areas—Towards stronger, connected, resilient and prosperous rural areas by 2040. The Vision proposes a Rural Pact and a Rural Action Plan aiming to make rural areas stronger, connected, resilient and prosperous. In an astounding shift, rural areas are now perceived as having the potential to build resilience to climate change, natural hazards and economic crises, having the ability to foster well-being. Several EU spatial and urban planning documents often integrate health as a concern, and increasingly so. But do EU health-related documents mention spatial and urban planning as a possible strategy to mitigate health matters?

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At EU level, the most relevant signal that change may be on the way, in a pre-pandemic context, is the final report of EU Joint Action on Mental Health and Well-being (2016) that to provide a European framework for action on mental health and well-being, included as solution the Mental Health in All Policies (MHiAP). This approach promotes population mental health and well-being by initiating and facilitating action within different non-health public policy areas. This is praiseworthy in the sense that health policy has a tendency to adopt a rigorous and limited approach of its scope of action, perhaps reflecting the same strict and narrow concept of health that prevails in the West. The West tends to privilege health, focusing on an individual’s body, adopting a diagnostic technique favouring the microscopic and the intensive examination of different parts separately. Also, it clearly divides health from the disease privileging the cure instead of prevention of disease. Other approaches to health privilege the individual’s body with its surrounding environment, adopting a holistic methodology where body and environment are in a constant dynamic that either promotes balance or imbalance. It favours adaptation to the surrounding environment instead of changing the environment (Tseui, 1978). In that sense, spatial and urban planning EU documents show a more holistic and nature-based view of health than the one that exists in health systems. Should this be perceived as a paradox or as conflict? Not necessarily. What could be said is, if spatial and urban planning strategies argue that ecosystems, green and blue infrastructures should be the main framework, then this perspective necessarily challenges the current prevailing limited view of health in Western health systems. Acknowledging this allows us to anticipate that sooner or later, as a consequence, the expansion of the concept of “health” in health systems will need to take place and only then this will be reflected in public policies design in the realm of health. Then intersectoral policies in health will be facilitated, which could significantly contribute to alleviating the heavy burden in budget spending that this area always represents in any country. The Mental Health in All Policies (MHiAP), in its aim to interact with non-health public policy areas, is, therefore, a refreshing and significant step in that direction. Recently, due to the impact that often crises have in accelerating impending tendencies, the current EU4Health Public Health Programme (Regulation, 2021) explicitly acknowledges the importance of mental

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health within health and explicitly calls for a change in public policies in promoting intersectoral strategies that promote health. It goes further, including as “health determinants” all those that are behaviourrelated, biological, socio-economic and environmental factors; declaring “emergency support” as a needs-based emergency “aimed at preserving life, preventing and alleviating human suffering, and maintaining human dignity” (see Chapter 3).

Recent Intersectoral EU Policy in Portugal In the 1800s, like in many other cities (Harris & Helgertz, 2019), the beginning of Portugal’s urban planning was sparked by the need to curb public health concerns. At the time, the major diseases affecting urban dwellers were cholera and yellow fever. Being both waterborne diseases, they have significantly decreased after a new sewage network system was put in place, improving both availability and quality of water supply. Currently, the main agenda-setting document in Portugal is the National Programme for a Spatial Planning Policy (PNPOT—Programa Nacional da Política de Ordenamento do Território; PNPOT, 2020) that proposes a strategy for 2020–2030. Does it address health matters? Which are its established priorities, and which strategies does it propose? In its first section, it refers to health concerns in the context of climate change that should require the adaption of infrastructures; also, new technologies are expected to bring changes in financing strategies and health provision services (eHealth); and social and economic changes should lead to a bigger focus on preventive health (pp. 19, 38, 46). It also states that urban areas should develop according to physical geography, favouring a green approach, positively impacting citizen’s health and well-being (p. 69). The document establishes five main domains to articulate its priorities: natural, social, economic, connectivity, territorial governance. Health is prioritised in the social domain (D2), being mentioned in three of its goals (2.3; 2.5; 2.9): (1) to build new health infrastructures and to improve existing ones, not disregarding connectivity and accessibility matters. To monitor this goal, it designates as relevant seven indicators based on data provided exclusively by the Ministry of Health. Unfortunately, assessment of new infrastructures and connectivity is not possible to monitor using these indicators (pp. 160, 161); (2) to improve quality of life of elderly population reinforcing intergenerational bonds. Here is

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aimed to take an integrated territorial approach to coordinate housing, mobility, health services, social services and proximity services. This goal features four indicators, but none accounts for housing and mobility (pp. 164, 165); (3) to encourage social innovation and strengthen sociocultural cohesion in low-density territories, promoting health initiatives (pp. 172, 173). Four additional measures in the territorial governance domain that specifically include health call for better geographic information to more effectively plan and manage all activities in the territory, including in health; to promote innovative solutions in health; to foster inter-urban cooperation to promote sustainable and environmentally clean smart cities; to reenforce cross-border cooperation to facilitate health accessibility. Serious governance issues become visible when the document lists 18 main problems concerning Portugal’s spatial and urban planning. Among them, three are acknowledged to hinder all other problems: production deficit and limited ability to access geographic information; insufficient cooperation culture and networks; territorial culture deficit (pp. 326, 327). These three problems impact what was defined by EU policies as priorities to implement regional policy: an effective multilevel governance system and a “territorial view” instead of a “land-use view”. Even if they would be the only priorities, solving these three problems would keep us busy for the next 10 years. They immediately put at risk the possibility of a successful implementation of the programme from the start. The proposed strategy to mitigate these is frail mainly because it does not include robust, selected, consistent, cohesive, harmonising, practical solutions. Also, concerning governance, the document provides an organigram for the implementation of PNPOT mapping all institutions. Though it is complex to interpret, it informs that there are monitoring, implementation and consulting institutions. Despite acknowledging that the current governance system is fragmented and that there is no framework put in place that facilitates coordination, hindering multilevel and intersectoral cooperation, the programme calls for “a more effective, efficient and responsible territorial governance” (p. 87). To accomplish this, it highlights the key role of bottom-up initiatives and local empowerment, along with the promotion of a new administrative culture, more proactive, focused on results and

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on solving problems (p. 89). Can bottom-up strategies and local empowerment succeed in a context with such stark multilevel and intersectoral insufficiencies that culminate in “territorial culture deficit”? In 2020, a Resolution issued by the Council of Ministers (48/2020, 24 June) determined that the governance model for implementing PNPOT should be operationalised by the Intersectoral Forum, specifically created to do so. The forum will be coordinated by the Portuguese DirectorateGeneral for Territory (DGT), an institution with administrative autonomy and integrated into the Ministry for Environment, under the responsibility of the government authority accountable for the spatial planning area. Main activities include monitoring and evaluate PNPOT to elaborate the Report on Spatial Planning’s State of the Art (REOT); to produce and disseminate available information that supports the creation of indicators at the national level; to encourage the implementation of PNPOT (PNPOT-FI, 2020). The commitment concerning indicators is particularly valued in the context of the subject of this book. However, the Intersectoral Forum is an institution created as an add-on to the existing structure, with severe pending governance and cooperation issues to solve (as I will address in Chapter 8). Up to which extent does the forum bring change to the existing governance system structure, making it more open and flexible? To create intersectoral strategies that impact the territory implies that each existing institution from each realm needs to reflect the same “intersectoral impulse”, actively engaging in a dialogue to co-create, co-implement, co-monitor and co-evaluate intersectoral policies. The EU cohesion policy in non-urban areas we analysed earlier (Kah et al., 2020) claimed that “there is no ‘one size fits all approach for rural areas”, adding that “[p]olicy needs to deal with the unique combinations of structural, social and geographic characteristics, and therefore requires tailored place-based approaches” (pp. 64, 65). The 2020–2030 PNPOT does not present a specific enough approach failing to clearly identify and elect priorities, designing specific strategies that allow making the most out of Portugal’s best features. One stark contradiction is, for example, claiming that the country needs to strengthen other urban areas, alleviating the pressure in coastal cities (mainly in the city’s capital Lisbon). Most would agree with this, both scientifically and at the common sense level. However, the strategy to make this happen in PNPOT is to foster innovation and international potential, which presupposes multilevel cooperation and connectivity (p. 63). The presupposition is known

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to be one of the most severe flaws in Portugal’s territorial governance, immediately boycotting the accomplishment of the goal. This type of rationale that often takes as presupposition cooperation, networks and territorial culture that is acknowledged not to exist allows us to anticipate that there will be a gap between the spatial planning programme PNPOT and strategic plans in several domains. We can only hope that the following PNPOT version covering the next 10 years (2030–2040) will take into account the country’s structural, social and geographic characteristics being selective in its goals and priorities, presenting a realistic tailor-made, place-based approach. More importantly, it designs a strategy to significantly contribute to solving the main obstacle in Portugal to any goal established in spatial and urban planning: cooperation, networks and territorial culture, which closely relates to renovating the governance system to facilitate multilevel and intersectoral policies. We can also take a different angle to analyse Portugal’s spatial and urban planning strategy by going back to a question posed in Chapter 4: is EU’s territorial cohesion policy uniform aiming at creating a planning system all over Europe, or is it providing a framework, where existing national planning systems remain intact? Portugal’s lack of internal territorial cohesiveness and frail horizontal and vertical governance systems makes it highly permeable to inadvertently fit a potential EU territorial cohesion policy. This is so in the sense that since the country does not clearly establish a “territorial view” by defining territorial priorities, these are slowly defined by an external dynamic. Adding to this, there is a misallocation of resources—between the late 1990s and 2015, Portugal’s productive resources were known to be misallocated to less efficient firms and less productivity sectors (Mongelli et al., 2015, p. 43). Though not explicitly addressed in spatial and urban planning documents, the EU has a uniform territorial cohesion policy which indirectly creates a planning system all over Europe. Founded on the place-based approach, each EU country or region is expected to affirm its uniqueness where each, instead of competing, complements each other, and diversity engenders growth. This dynamic is visible in the gradual economic specialisation of each Member State. In this, there is a clear South and North of Europe divide. Portugal, a Southern European country, specialises in tourism which has become, over the years, the assigned place-based activity that fits the EU territorial cohesion puzzle, merging

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economic and regional/urban policies. Being highly labour intensive, Portugal shows lower productivity levels than other European regions with better education and innovation levels—despite tourism being less critical for those regional economies. These claims are supported by Romão and Nijkamp (2019), who conclude that the thriving tourism industry is becoming increasingly linked to a high drive in knowledgebased activity. But what does this mean exactly? What is the territorial consequence of such a statement? Tourism is known to be a highly volatile economic activity that shows little resistance to internal and external shocks (ranging from political conflicts, natural disasters to epidemic diseases). Although it fits the EU cohesion policy puzzle, the risk of founding an economy in tourism implies a greater risk than other placebased activities. Two strategies are possible to address this—that can be complimentary. Either this implies a negotiated and agreed-upon additional protection from the EU, in case a crisis or external shock hits, or along with Zibanai (2014), I claim that countries that heavily rely on tourism as the main economic source of revenue should promote economic diversification, proactive crisis management and recovery strategies. For this to occur, an economic diversification strategy needs to be designed, which will align with certain priorities that will take precedence in the country’s “territorial view”, which will be the decisive factor that aligns the renewal of the governance system. Without intent, no overarching agenda will succeed. In Chapter 4, I quoted Alves Correia (2014, p. 21), who referring to spatial and urban planning laws, claimed that it is always easier to change any given legislation than to promote a better context that allows for existing laws to actually work. This means that existing legislation is satisfactory, but institutions, governance systems, and policy do not provide a sufficiently robust context that allows for a successful operationalisation of legislation. Also mentioned in Chapter 4, the Portuguese National Health Plan 2012–2016 (2013), extended until 2020, mentions in its bibliography the European Healthy Cities Network, WHO’s Healthy Cities Network and the Portuguese Healthy Cities Network. However, there is no specific mention of an articulation with spatial and urban planning policies. Additionally, there is a constant reference to the need to reorganise Portugal’s hospital network and this concerns spatial and urban planning. However, also no mention of intent concerning intersectoral policies is found.

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The current Portuguese governance system hinders sectoral and intersectoral policies. The lack of regional mechanisms (ARS/Regional Administration for Health) to monitor implementation of mental health services and partnerships based on quality standards (Caldas de Almeida et al., 2015, p. 311) matches the lack of regional mechanisms in spatial and urban planning (CCDR/Regional Coordination and Development Committees) analysed in Chapter 4.5 The multilevel flow between national, regional and local levels is not working. Because of this, not only sectoral policies show low implementation levels as intersectoral approaches are hampered. is it essential and urgent to change this? At this point, I go back to the TAEU 2030, to the New Leipzig Charter and the Green Infrastructure Strategy (EC, 2013), claiming that the similarities between their content and Ribeiro Telles’s proposals, which started taking shape in the 1970s, are many. All subscribe that nature-based and holistic solutions should be the foundation privileging ecosystems, green and blue infrastructure over grey infrastructure. A framework that favours natural solutions will ensure that we have ecological, economic and social benefits. This is both valid in urban and non-urban areas. This framework supports a closer interaction between spatial and urban planning and health. Additionally, climate change concerns and the COVID-19 pandemic reinforced this approach contributing to unveiling the long-overdue link between these two sectors. The European Green Deal strives for Europe to be the first carbon– neutral continent up until 2050. Its benefits are articulated to “improve the well-being and health of citizens and future generations” (EC-EGD, 2021). In the context of the ongoing pandemic, on 18 January 2021, the New European Bauhaus initiative was launched, explicitly acknowledging and encouraging the potential of simultaneously addressing urban design, spatial and urban planning and health by “inspiring discussions about, and the transformation of, the places where we live”.

5 Portugal has five ARS and five CCDR, each acting in its sector, ARS in health and

CCDR in spatial and urban policies. However, each has to the same territorial scope, and each has a regional headquarters in the same cities: ARS Norte (Porto); ARS Centro (Coimbra); ARS Lisboa e Vale do Tejo (Lisboa); ARS Alentejo (Évora); ARS Algarve (Faro); and CCDR Norte (Porto); CCDR Centro (Coimbra); CCDR Lisboa e Vale do Tejo (Lisboa); CCDR Alentejo (Évora); CCDR Algarve (Faro).

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However, it specifically calls for “artists, designers, engineers, scientists, entrepreneurs, architects, students, and all interested people”, failing to mention health professionals. This seems to confirm that it is easier for spatial and urban planning professionals to leave their comfort zone and address health concerns than health professionals to reach out to spatial and urban planning professionals. In reality, both need to engage in a fruitful dialogue, be respectful of each other’s knowledge and practising active listening to forge new solutions. Spatial and urban planning and health, not only are scientifically attested as being advantageously addressed jointly as recent broad EU agenda-setting documents, clearly encourage that this is implemented policy-wise. In the past, perhaps multilevel approaches and intersectoral policies linking both areas were perceived as an out of the box, exotic idea. At this point, if there was ever any doubt, they are a priority playing a pivotal role in climate change mitigation strategies, decreasing health impacts of future pandemics and lowering annual national expenses with non-communicable diseases.

References Alves Correia, F. (2014). A nova lei de bases gerais da política de solos, de ordenamento do território e de urbanismo: Alguns princípios fundamentais. RevCedoua, 34, 9–21. Berardi, C., Antonini, M., Genie, M. G., Cotugno, G., Lanteri, A., Melia, A., & Paolucci, F. (2020). The COVID-19 pandemic in Italy: Policy and technology impact on health and non-health outcomes. Health Policy and Technology, 9(4), 454–487. https://doi.org/10.1016/j.hlpt.2020.08.019 Caldas de Almeida, J. M., Mateus, P., Xavier, M., & Tomé, G. (2015). Joint acton on mental health and well-being. Towards community-based and socially inclusive mental health care. Análise da situação em Portugal. Sociedade Portuguesa de Geriatria e Gerontologia Website. http://spgg.com. pt/UserFiles/file/23_09_15report_JA_em_PORTUGUES.pdf Centers for Disease Control and Prevention. (2021). SARS-CoV-2 variant classifications and definitions. https://www.cdc.gov/coronavirus/2019-ncov/var iants/variant-info.html EC. European Commission. (2011). Green infrastructure and territorial cohesion. https://www.eea.europa.eu/themes/publications/green-infrastructureand-territorial-cohesion

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EC. European Commission. (2013). Green infrastructure (GI)—Enhancing Europe’s natural capital—COM (2013). CELEX number: 52013DC0249. https://eur-lex.europa.eu/ EC. European Commission. (2021). A long-term vision for the EU’s rural areas. https://ec.europa.eu/info/strategy/priorities-2019-2024/new-pusheuropean-democracy/long-term-vision-rural-areas_en#documents EC-EGD. European Commission-European Green Deal. (2021). Strategy, Priorities 2019–2024, A European Green Deal. https://ec.europa.eu/info/str ategy/priorities-2019-2024/european-green-deal_en EU Joint Action on Mental Health and Wellbeing. (2016). European framework for action on mental health and wellbeing. Final Conference—Brussels (21–22 January). https://ec.europa.eu/research/participants/data/ref/h2020/ other/guides_for_applicants/h2020-SC1-BHC-22-2019-framework-for-act ion_en.pdf Harris, B., & Helgertz, J. (2019). Urban sanitation and the decline of mortality. The History of the Family, 24(2), 207–226. https://doi.org/10.1080/108 1602X.2019.1605923 Kah, S., Georgieva, N., & Fonseca, L. (2020). EU cohesion policy in non-urban areas. European Parliament Website. Policy Department for Structural and Cohesion Policies, Brussels. https://www.europarl.europa.eu/RegData/etu des/STUD/2020/652210/IPOL_STU(2020)652210_EN.pdf Li, Q., Guan, X., Wu, P., Wang, X., Zhou, L., Tong, Y., & Feng, Z. (2020). Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. New England Journal of Medicine, 382, 1199–1207. https://doi. org/10.1056/NEJMoa2001316 Mongelli, F.P., Reinhold, E., & Papadopoulos, G. (2015). What’s so special about specialisation in the euro area? Early evidence of changing economic structures. European Central Bank. https://doi.org/10.2866/34495 National Health Plan 2012–2016. (2013). Summarised version (May). DirecçãoGeral de Saúde. https://pns.dgs.pt/nhp-in-english/ NLC. New Leipzig Charter. (2020). Adopted at the Informal Ministerial Meeting on Urban Matters on 30 November 2020. EU2020.DE. European Commission Website. https://ec.europa.eu/regional_policy/sources/docgener/bro chure/new_leipzig_charter/new_leipzig_charter_en.pdf OECD/EU. (2018). Health at a glance: Europe 2018: State of health in the EU Cycle. OECD Publishing. https://doi.org/10.1787/health_glance_eur2018-en Padma, TV. (2021). COVID vaccines to reach poorest countries in 2023— Despite recent pledges. Nature, 595, 342–343. https://doi.org/10.1038/ d41586-021-01762-w Pinker, S. (2015). The village effect: How face-to-face contact can make us Healthier, Happier, and Smarter. Penguin Random House.

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Pinker, S. (2017, April). The secret to living longer maybe your social life [Video]. TED Conferences. https://www.ted.com/talks/susan_pinker_the_secret_to_ living_longer_may_be_your_social_life PNPOT 2020. (2019). Programa Nacional da Política do Ordenamento do Território (PNPOT). Lei n.o 99/2019 de 5 de setembro Diário da República n.o 170/2019. Direcção-Geral do Território. https://pnpot.dgterritorio.pt/ pnpot Regulation. (2021). EU Health Plan, EU4HHealth. Regulation (EU) 2021/522. European Commission. https://ec.europa.eu/health/funding/eu4health_en Romão, J., & Nijkamp, P. (2019). Impacts of innovation, productivity and specialisation on tourism competitiveness—A spatial econometric analysis on European regions. Current Issues in Tourism, 22(10), 1150–1169. https:// doi.org/10.1080/13683500.2017.1366434 Sasse, T. (2021). Tackling Covid-19 over the long term How to strengthen international efforts to end the pandemic. [IfG Insight] (July). Institute for Government, UK. https://www.instituteforgovernment.org.uk/sites/def ault/files/publications/tackling-covid-long-term.pdf Scholz, N. (2021). Mental health and the pandemic. [Briefing]. European Parliamentary Research Service. European Parliament, Members’ Research Service. PE 696.164 (July). https://www.europarl.europa.eu/RegData/etu des/BRIE/2021/696164/EPRS_BRI(2021)696164_EN.pdf TAEU 2030. (2020). Territorial Agenda for the European Union 2030 (1 December, Germany). Informal meeting of Ministers responsible for spatial planning, territorial development and/or territorial cohesion https://territori alagenda.eu/wp-content/uploads/TA2030_jun2021_en.pdf Tseui, J. J. (1978). Eastern and western approaches to medicine. The Western Journal of Medicine, 128(6), 551–557. WHO. (2020). WHO director-general’s opening remarks at the media briefing on COVID-19—11 March 2020. World Health Organization Website. https://www.who.int/director-general/speeches/detail/who-director-gen eral-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 Zibanai, Z. (2014). Is the tourism industry a fragile heavy weight? Validation through a literature review of tourism system shocks. Journal of Tourism Management Research, Conscientia Beam, 1(1), 1–13. https://ideas.repec. org/a/pkp/jotmre/2014p1-13.html

CHAPTER 7

2030 Agenda

Brief Review of Previous Strategies and How They Address Health and Cities The 2030 Agenda for Sustainable Development, establishing 17 Sustainable Development Goals, was adopted in September 2015 by the United Nations General Assembly in New York, USA (UNGA, 2015). “Sustainable development” and “sustainability” have been the main concepts behind previous UN initiatives. The 1992 UN Conference on Environment and Development (“Rio Earth Summit”), the 2002 World Summit on Sustainable Development (in Johannesburg, South Africa) and the 2012 UN Conference on Sustainable Development (“Rio plus 20”). But the 2030 Agenda goes one step further, detailing content corresponding to the concept of sustainable development, identifying specific targets for each goal adopting a broad scope vision (Kanie et al., 2017). The strategy of associating goals and specific targets to an agenda is not new. In 2000, the UN Millennium Summit adopted the United Nations Millennium Declaration defining eight international development goals as priorities up until 2015, known as Millennium Development Goals (MDGs).1 The current 2030 Agenda, renews and updates the MDGs. 1 Goal 1: Eradicate extreme poverty and hunger; Goal 2: Achieve universal primary education; Goal 3: Promote gender equality and empower women; Goal 4: Reduce child mortality; Goal 5: Improve maternal health; Goal 6: Combat HIV/AIDS, malaria and

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There are two main differences between MDGs and SDGs: the SDGs agenda is more comprehensive (especially when it comes to the environmental dimension) and is universal (not only countries in the Global South but also countries in the Global North have subscribed to it). The SDGs are much more integrated, and there are connections, implicit and explicit, between different goals and targets (Monkelbaan, 2019, p. 4). More importantly, the MDGs were not negotiated outcomes. In contrast, the SDGs involved over two years of intense intergovernmental stocktaking and negotiation sessions, and perhaps the largest public and multi-stakeholder consultations in UN’s history (Kanie et al., 2017, p. 3). These implicit and explicit connections go beyond what the 2030 Agenda may seem at first due to the central role of the environmental dimension: a document for environmental policy integration, referring to the integration of environmental concerns into other sectoral policies. However, Bornemann and Weiland (2021) argue that a careful analysis of the 2030 Agenda allows us to understand that the Agenda promotes a comprehensive, reciprocal and complex form of goal integration which differs markedly from environmental policy integration. Policy integration is based on a functionalist logic of prioritisation, identifying priority goals as leverage for improving the overall system. This identification is evidence-based, and in that sense, the role of knowledge and evidence is paramount because they provide the basis for managing and optimising the complex relations between goals and targets. Also, Goal 17, “Partnerships for the Goals”, adds a managerial account of sustainable development focusing on solving conflicts, acknowledging benefits to different actors with and potential trade-offs. It includes mobilisation at regional and national levels and among multiple civil society, financial and business actors.2 The 2030 Agenda is a broad, comprehensive document that aims to be the start of a much longer conversation across countries, sectors, actors and governance levels. It represents a compromise among different countries, but it aspires to political implementation in each of those countries.

other diseases; Goal 7: Ensure environmental sustainability; Goal 8: Global partnership for development. 2 For a correlation between goals, see UN-ST (2019).

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How does this implementation take place fully depends on the subsequent political process.3 Have previous UN agendas jointly addressed spatial and urban planning and health? One of the achievements of the 1992 UN Conference was Agenda 21 (1992). In it, both sectors are addressed first in Chapter 5, dedicated to demographic dynamics and sustainability. Main concerns include the rise of sea level combined with the increasing number of cities and population worldwide concentrated in the coastal area (at the time, around 60%); and the need to improve municipal management and local government, particularly addressing the needs of women and children. Other chapters call for control of water pollution and better and solid waste management (Chapters 6 and 18); improving management and living conditions, arguing for an intensification with the Sustainable Cities Programme of Habitat and the Healthy Cities Programme of WHO (chapter 7); a comprehensive approach to planning that recognises that the individual needs of cities and are based on ecologically sound urban design practices (Chapter 7); and better cooperation involving local authorities (Chapter 28). The 2002 World Summit on Sustainable Development (WSSD, 2002) mentions the initiative “Cities without slums”, an action plan that aimed to reduce world population living in slums by 2020. Apart from that, the main concern in this document is health, health care and well-being at many different levels, but the connection between this sector and spatial and urban planning is not featured. The United Nations Conference on Sustainable Development, Rio + 20 (2012) launched the process to develop the SDGs, which should build on, and renew, the MDGs. When addressing urban environments, it featured some elements that jointly consider cities and health, calling for resilience of cities; a holistic approach so that cities can promote economically, socially and environmentally sustainable societies; strengthening local authorities; balancing cities with rural regions; urban planning and design as a way to respond effectively to the expected growth of urban populations in the coming decades; revitalisation of older cities and neighbourhoods; and better cooperation mechanisms. When it comes to health, it establishes the connection between human health and the environment; 3 For a discussion of types of international goal setting, goal setting as a governance strategy, and main critiques, see Kanie et al. (2017).

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it calls for a healthy living environment for all; the need to restore the health and integrity of the Earth’s ecosystem; it links the social and environmental determinants of health to the right to the enjoyment of the highest attainable standard of physical and mental health; and it highlights the importance of access to and investment in health systems. In the 2030 Agenda (2015), Goal 3 addresses “Health and Wellbeing” and Goal 11 “Cities and Sustainable Communities”, featuring nine and seven associated targets, respectively. Goal 11 is dedicated to cities, including health concerns in all its seven targets: upgrade slums (11.1), adopt sustainable transport systems (11.2), foster sustainable urbanisation (11.3), protect natural heritage (11.4), promote city resilience (11.5), reduce water and air pollution (11.6), increase inclusive access to green and public spaces (11.7). Goal 3, addresses cities in two of its goals: decrease global death and injuries from road traffic accidents (3.6); and decrease air, water and soil pollution (3.9). Particularly significant among Goal 3 is target 3.4 that aims to, by 2030, “reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being”. Non-communicable diseases include mental health conditions, cardiovascular diseases, diabetes, preventable cancers, chronic respiratory diseases (including asthma) and injuries. This target is extremely important because it acknowledges the beneficial role of a preventive approach to health in non-communicable diseases (instead of a disease approach) (see Chapter 6). This aligns with the thesis presented in this book, supported by extensive scientific evidence, that spatial and urban planning (design and policies) can play a vital role in decreasing non-communicable diseases, positively impacting, among other, mental health conditions. How to translate 2030 Agenda goals and targets at the national level? How to transform them and implement them on the ground? Are national governance systems ready for the kind of intersectoral flexibility that the 2030 Agenda calls for with its policy integration approach?

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Indicators: To Evaluate Implementation. Advantages and Disadvantages of Indicators Associated with “Goals” Instead of “Rules/Laws”. Up to What Extent it is Possible to Translate Abstract and Universal Principles to the National Scale. Is This Strategy Effective? The 2030 Agenda was one of the documents that influenced the drafting of TAEU 2030 and the New Leipzig Charter. In both EU agenda-setting documents, cities and urban areas are the gravitational centres of sustainable growth, being the element that allows for policy integration and, ultimately, what implements regional and cohesion policy. Cities are the main element of policy integration, empowering many others. But how does this integration operationalises? Part of the answer can be found in the 2030 Agenda, to some extent in Goal 16 and Goal 17. These goals, not only are the Agenda’s epicentre as they also provide a sophisticated and detailed account of the expected new and innovative governance system that an integrative, comprehensive, intersectoral and multilevel approach calls for. This impacts the way countries relate with transnational institutions but, more importantly, how national, regional and local levels interact. I find Goal 16, “Peace, Justice, and Strong Institutions”, one of the most challenging. Centred injustice, inclusion and accountable institutions, monitoring and measuring governance mechanisms create a host of practical and political dilemmas for countries at different levels of development and domestic circumstances. According to Kanie et al. (2017, pp. 21, 22), many countries “lack statistical capacity, disaggregated data, or monitoring capacity”, and this compromises “comparable measurement and systemic or integrated analysis of data”. However, authors add that though this raises political issues and potential conflicts, these can be overcome “through institutional arrangements that may also serve to orchestrate or create linkages among existing agreements”. Still, in particular, Goals 16.3, 16.5 or 16.6 are extremely challenging to monitor. How to assess if progress is being made in equal access to justice for all, or if corruption and bribery are being reduced, or if institutions are being fully transparent and accountable? These are problematic targets because comparing a “before” and “after” even if measures are implemented accounts for very little since these activities occur under omission being currently invisible to the system. Making the best of these highly

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commendable targets, what can be done is to ensure that rules and regulations are put in place, making them more visible, and implementing a penalty. Goal 16, to succeed, is the one that requires more binding instruments at the national level and therefore is that one that is at the utmost conflict with the Agenda’s nonbinding nature. A serious boost on how to operationalise Goal 16 is given in targets associated with Goal 17 that specifically address finance (17.1–17.5); technology (17.6–17.8); capacity building (17.9); trade (17.10–17.12); and systemic issues (17.13–17.19) related with policy and institutions, multi-stakeholder partnerships and data, monitoring and accountability. Closely analysing targets associated with systemic issues, I highlight some key expressions that are used: “policy coordination and policy coherence”; “[r]espect each country’s policy space and leadership”; “encourage and promote effective [multi-stakeholder] partnerships”; “increase significantly the availability of high-quality, timely and reliable data”; “to develop measurements of progress on sustainable development”. All these concern governance systems and closely relate with Goal 16, providing several “how-to” elements. It could also be said that these sum up the core of the 2030 Agenda: a new governance system for policy integration. Which are the advantages and disadvantages of indicators associated with “goals” instead of “rules/ laws”? Up to what extent it is possible to translate abstract and universal principles to the national scale? Is this strategy effective? According to the 2030 Agenda, the Inter-Agency and Expert Group developed the global indicator framework on Sustainable Development Goal Indicators, agreed by the Statistical Commission in March 2016 and adopted by the Economic and Social Council and the General Assembly (2030 Agenda, p. 32). In the same paragraph, it reads: “[Goals and targets] will be complemented by indicators at the regional and national levels which will be developed by Member States, in addition to the outcomes of work undertaken for the development of the baselines for those targets where national and global baseline data does not yet exist”. This information is not secondary, and it should not be dismissed in any case. This is a clear indication of how the Agenda can be used to the advantage of each country, showing adaptability and flexibility to design a set of tailor-made indicators that better fit any given country that contributes to sustainable development. Some indicators can result from existing or new laws, and others may not. It is up to each country to mobilise its resources in the best possible way to maximise effectiveness.

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As stated in Chapter 4, let us also keep in mind that ultimately the goal of the Agenda is to encourage institutional change at the system level. Goals have a time frame (an expiration date, so to say), but if they permeate the system as rule/law, they become timeless. This assures that over time, renewal and transformation will take place. To decide which indicators stem from the law, which arise from informal agreements documented in nonbinding instruments, is up to each country. To Identify the Advantages of a Multi-Criteria Statistical Method that Assesses Several Indicators Simultaneously—Being the Most Adequate Method to Monitor an Initiative that Defines Goals What is the most adequate method to monitor an initiative that defines goals? Each goal, due to the policy integration approach, includes a reflection of several others. This results in added complexity and layering that, according to each country, becomes unique. It is up to each country to decide which indicators and which set of indicators are relevant to account for progress. The goal is that the 2030 Agenda is perceived as an opportunity to raise the bar and hopefully spark the will to be better. Ideally, it is not about “looking good” when compared to others but to become better. Due to the complexity of goals and respective targets, the selection of indicators to monitor progress should not be oversimplified. This means that to track advances concerning one goal/target, it is possible that indicators from other areas, ministries and institutions become relevant. A quick example can be, for example, a country that decides that it is a priority to provide clean water (Goal 6) to a given set of cities (Goal 11), contributing to decrease disease and mortality rates (Goal 3). To monitor this kind of initiative, it is necessary to rely on indicators from different institutions that cover different areas. To rely on indicators that simply monitor water pollution would fail to assess the initiative’s overall impact. It is important that each country establishes its own priorities and defines its own set of indicators. To facilitate decision-making and to evaluate progress as accurately as possible, multi-criteria analysis can be a good tool because it goes beyond a simplistic attitude, inspiring the design of intersectoral policies that have the ability to be effective across different sectors magnifying any given investment. For example, to many countries, it is highly reductionist to consider that Goal 11, sustainable cities and communities, has significantly

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improved because there is an indicator that let us know that there was an increase in available housing due to an initiative that had government support. This indicator alone is mute when it comes to access, gender equality, transparency, etc. This is why multi-criteria analysis (MCA) is a powerful alternative to overcome the shortcomings of traditional decision-support tools allowing us also to overcome conventional prejudices disseminated by economics, such as cost–benefit (CBA) or cost-effectiveness analysis (CEA). These types of analysis are valid but, when used on their own or when prioritised, provide a flat and too superficial analysis of any given situation that is disconnected from real-life situations. Ultimately these can lead to overspending by overlooking more encompassing ways of allocating resources that can simultaneously benefit one or more sectors. The foundations of sustainable development lie in a perspective of economics that goes beyond growth and aims at prosperity, a more comprehensive and all-encompassing viewpoint that includes the social, cultural and ecological realms (Jackson, 2011). This matches the 2030 Agenda approach. That is why a multi-criteria analysis that supports decision-making can be helpful. The assumption is that MCA’s also has the potential to support complex decision problems in the realm of public decision-making. According to Gamper and Turcanu (2007), literature suggests that MCA facilitates stakeholders’ involvement at national and supra-national levels, being able to incorporate qualitative elements and public values. In general, cases connected with governmental decisions vary according to context. Usually, they subscribe to one of the following families (Vincke, 1992): (i) multi-attribute utility (MAUT) methods, seeking to aggregate all points of view into a unique function which is to be optimised; (ii) outranking methods, which construct and exploit a synthesising relation based on the decision-maker’s preferences; and (iii) interactive, trial–error methods, which explore the space of feasible alternatives through a dialogue with the decision-makers (Gamper & Turcanu, 2007, p. 302). A simple account of what MCA is in the context of public policy is provided in Fig. 7.1. An updated account of recent developments in MCS, particularly in the realm of sustainability and emphasising the role of participatory processes, is provided by Etxano and Villalba-Eguiluz (2021). Conducting an extensive literature review to assess the robustness of MCS, they analyse sustainability in a context that privileges the social realm and focus on

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Fig. 7.1 Gamper and Turcanu (2007, p. 305)

social multi-criteria evaluation (SMCE). Authors claim that there are three main reasons why sustainability can be addressed in SMCE, namely (i) operationalisation of the strong sustainability principle, (ii) incorporating the social actors’ views through participative processes and (iii) searching for compromise solutions when implementing SMCE. They also take three main conclusions: (i) that SMCE is usually used in conjunction with NAIADE, an aggregation method includes uncertainty through fuzzy sets but also allows the parameters to be modulated to align according to weak or strong sustainability; (ii) that is necessary to address participatory processes linked to the local scale, the influence of the social actors and assure transparency; (iii) that compromise is not easy and therefore, evaluation alternatives are not necessarily durable over time; this implies that SMCE application has been focused on methodological and research approaches, rather than used in real policy settings where recommendations as regards alternatives may be effectively implemented (see Fig. 7.2, Etxano & Villalba-Eguiluz, 2021). This means that MCA or the more sophisticated method SMCE does not replace leadership, which includes motivation and negotiation skills. I argue that the effectiveness of SMCE highly depends on who defines the problem and how is the problem defined; who identifies the relevant

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Fig. 7.2 SMCE process by steps. Etxano and Villalba-Eguiluz (2021)

social actors and stakeholders and how are they identified; who selects evaluation criteria and how are evaluation criteria selected; and ultimately, who ranks the alternatives and how are alternatives ranked. To sum up, relying on a multi-criteria statistical method solves the second half of the problem but not the first part, which relates to power, authority, legitimacy and transparency. How to ensure that there are mechanisms to ensure that data accounted for in the model is representative, inclusive and equitable? Models often tend to over-simply complex matters. In this book, I aim not to suggest a specific multi-criteria framework but to lay the foundations that allow assuring that any future model is aware of all relevant pieces of the puzzle and aware of the complexity of the task at stake when it comes to assessing several indicators that allow evaluating the efficacy of intersectoral policies in the realm of spatial and urban policies, and health. Before data being modelled, there needs to be a reliable availability of real-world data.

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To Present the Process of Creating Indicators and Indexes in Portugal Concerning SDGs In February 2016, one month after the 2030 Agenda took effect, the Portuguese Council of Ministers decided to adopt several measures that would allow defining its implementation strategy. To articulate its external dimension, a Committee for Interministerial Cooperation was created, supported by Instituto Camões, a Portuguese international institution dedicated to the worldwide promotion of the Portuguese language, Portuguese culture and international aid. It aimed at promoting international civic, private and public partnerships. Accounting for the internal dimension of the implementation, a Committee for Interministerial External Policy was established articulating all Ministries. In 2017, it presented a National Voluntary Report.4 That accounted for a state of the art concerning each goal. Two entities were designated to provide technical consultancy: Statistics Portugal/INE, in charge of providing statistical information and assessment of indicators; and Agency for Development and Cohesion/AD&C, responsible for coordinating EU’s Structural Policy and Regional Policy. Among invited partners were Portugal Global/AICEP, created in 2007 it is an independent public entity of the government of Portugal, intending to attract foreign investment to Portugal and Visit Portugal and UNESCO National Committee (MNE, 2017). At the national level, it was established that the Ministry of Health was responsible for Goal 3 (health) and the Ministry for the environment accountable for Goal 11 (sustainable cities). Additionally, Goal 16, “Peace, Justice and Strong Institutions”, was allocated to the Ministry of Justice and Goal 17 “Partnerships for the Goals”, to the Ministry of Foreign Affairs.5 4 To date, Portugal has presented one report on 18 July 2017. It has itemised ongoing initiatives concerning each goal presenting a state of the art of each goal. Concerning Goal 3 it has reported initiatives mainly in the realm of tobacco risk mitigation, road safety, nutrition and health programmes, a mental health plan, a vaccination programme and a national health system. Concerning Goal 11, it has reported initiatives on affordable housing, a green transport system, preservation of landscape, cities resilient to crisis and hospital waste management (NVR, 2017). 5 SDG 1; SDG 8; SDG 10—Ministry for Work, Solidarity and Social Security (MTSSS); SDG 2—Ministry for Agriculture, Forests and Rural Development (MAFDR); SDG 3— Ministry for Health (MS); SDG 4—Ministry for Education (ME); SDG 5—Adjunct Minister—State Secretary for Citizenship and Equality (SECI); SDG 6; SDG 11; SDG

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The National Voluntary Report (NVR, 2017, p. 87) provides a very useful survey of available indicators at the national level. Three main references were taken into account: (1) the set of 241 indicators6 adopted in March 2016 during the 47th meeting of the United Nations’ Statistical Committee (UNSC) (IAEG-SDG 2016)7 ; (2) Eurostat that has also presented its own set of indicators in 2018, based on UN’s and adopting others relevant to the EU context8 ; (3) Statistics Portugal on 10 May 2016 has created a multidisciplinary Working Group dedicated to monitoring the implementation process “Agenda 2030 – Sustainable Development Goals” (GTSDG) being main concerns methodological robustness and data availability. The Ministry for Foreign Affairs (MNE 2017) elected priority goals at the national level: Quality Education (Goal 4); Gender equality (Goal 5); Industry, Innovation and Infrastructures (Goal 9); Reduced Inequalities (Goal 10); Climate Action (Goal 13); and Life Below Water (Goal 14). Being Portugal a Member State of the EU where cohesion policy is implemented through regional policy and cities are its gravitational centre, it is puzzling that sustainable cities and communities (Goal 11) do not feature among priority goals. However, when consulting the National Voluntary Report (NVR 2017, p.87), out of 17 goals, only 7 have a data availability of over 50%

12; SDG 13—Ministry for the Environment (MAmb); SDG 7—Ministry for the Economy (MEco); SDG 9—Ministry for Planning and Infrastructures (MPI); SDH 14—Ministry for the Maritime Affairs (Mar); SDG 15—Ministry for Agriculture, Forests and Rural Development (MAFDR): SDG 16—Ministry for Justice (MJ); SDG 17—Ministry for Foreign Affairs (MNE). 6 “[T]he total number of indicators listed in the final indicator proposal is 241. However, since nine indicators repeat under two or three different targets, the actual total number of individual indicators in the list is 230” (IAEG-SDGs 2016). 7 On 6 March 2015, during the 46th session of UNSC, the Inter-agency and Expert Group on Sustainable Development Goal Indicators (IAEG-SDG) was created for creating the set of indicators (MNE, 2017; UNSD, 2016). The most recent updated version of SDGs indicators can be found on UNSTATS (2021). The next revision will be reviewed comprehensively by the Statistical Commission during its fifty-sixth session in 2025. After the last revision in March 2021, the global indicator framework includes 231 unique indicators, however, the total number of indicators listed in the global indicator framework of SDG indicators is 247 because twelve indicators repeat under two or three different targets. 8 The Eurostat 2021 updated list of SDGs indicators can be consulted on EUROSTATEC 2021.

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considering the 241 indicators suggested by the UN. With an availability below 25% are Gender equality (Goal 5), Climate Action (Goal 13) and Life Below Water (Goal 14) which are three out of six Portugal’s priority goals. It would be expected that a solution on how to overcome this would be articulated or at least that the difficulty would be acknowledged, but that is not the case. The most recent update on data availability (INE, 2021, p. 45) states that overall, 62% of all indicators have available data with 11 goals above 50%. Among goals with lowest availability are Goal 2 “No Hunger” (43%); Goal 5 “Gender Inequality” (43%); Goal 12 “Responsible Consumption and Production” (38%); and Goal 13 “Climate Action” (38%). The top three are Goal 9 “Industry, Innovation and Infrastructures” (92%), Goal 3, “Good Health and Well-being” (86%) and Goal 7 “Affordable and Clean Energy” (83%). In 2017 (MNE), no reference is made concerning the opportunity to add specific national indicators. In the most recent report by Statistics Portugal accounting for SDGs indicators (INE, 2021), the list does identify any new indicator at the national level. Both the 2017 Ministry for Foreign Affairs draft for the implementation of the 2030 Agenda and the National Voluntary Report have a significant gap providing no account on how is the current national governance system going to adapt to the policy integration approach of the Agenda, leaving it up in the air on how will intersectoral and multilevel interaction is facilitated. In Chapter 8 I suggest which changes and processes can be applied to assist and accelerate intersectoral and multilevel health and spatial and urban policies.

References 2030 Agenda. (2015). A/RES/70/1—Transforming our world: The 2030 Agenda for sustainable development. United Nations. https://sdgs.un.org/2030ag enda Agenda 21. (1992). Sustainable development goals—Knowledge platform. United Nations. https://sustainabledevelopment.un.org/milestones/unced Bornemann, B., & Weiland, S. (2021). The UN 2030 agenda and the quest for policy integration: A literature review. Politics and Governance, 9(1). https:// doi.org/10.17645/pag.v9i1.3654 Etxano, I., & Villalba-Eguiluz, U. (2021). Twenty-five years of social multicriteria evaluation (SMCE) in the search for sustainability: Analysis of case

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studies. Ecological Economics, 188, 107131. https://doi.org/10.1016/j.eco lecon.2021.107131 EUROSTAT-EC. European Commission. (2021). EU SDG Indicator set 2021: Result of the review in preparation of the 2021 edition of the EU SDG monitoring report. Directorate E: Sectoral and Regional Statistics Unit E-2: Environmental statistics and accounts; sustainable development. Final version of 15/01/2021. https://ec.europa.eu/eurostat/documents/ 276524/12239692/SDG_indicator_set_2021.pdf Gamper, C. D., & Turcanu, C. D. (2007). On the governmental use of multicriteria analysis. Ecological Economics, 62(2), 298–307. https://doi.org/10. 1016/j.ecolecon.2007.01.010 INE. Instituto Nacional de Estatística. (2021). Objetivos de Desenvolvimento Sustentável—Agenda 2030. Indicadores para Portugal: 2010–2020. https:// www.ine.pt/xurl/pub/280981585 Jackson, T. (2011). Prosperity without growth. Earthscan. Kanie, N., Bernstein, S., Biermann, F., & Haas, P. M. (2017). Introduction: Global governance through goal setting. In N. Kanie & F. Biermann (Eds.), Governing through goals: Sustainable development goals as governance innovation (pp. 1–27). MIT Press. MNE. Ministério dos Negócios Estrangeiros. (2017, June 28), A Agenda 2030 em Portugal—Informação à Imprensa. https://issuu.com/comissaonaciona ldaunesco/docs/agenda_2030_em_portugal Monkelbaan, J. (2019). Governance for the sustainable development goals exploring an integrative framework of theories, tools, and competencies. Springer Nature. NVR. National Voluntary Report. (2017). Comissão para a Cidadania e a Igualdade de Género Website. https://www.cig.gov.pt/wp-content/uploads/2017/ 07/Portugal2017.pdf Rio+20. (2012). United Nations conference on sustainable development, Rio+20. RA/RES/66/288. United Nations. https://sustainabledevelopment.un.org/ rio20 UN-ST. United Nations Statistical Commission. (2019). Interlinkages of the 2030 Agenda for Sustainable Development. Prepared by the Interlinkages Working Group of the Inter-Agency and Expert Group on Sustainable Development Goal Indicators (IAEG-SDGs). Fiftieth session (5– 8 March). https://unstats.un.org/unsd/statcom/50th-session/documents/ BG-Item3a-Interlinkages-2030-Agenda-for-Sustainable-Development-E.pdf UNGA, United Nations General Assembly. (2015). Transforming Our World: The 2030 Agenda for Sustainable Development. Draft resolution referred to the United Nations summit for the adoption of the post-2015 development agenda by the General Assembly at its sixty-ninth session. UN Doc. A/70/L.1. https://www.un.org/

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UNSD. (2016). Working group on interlinkages of SDG statistics to allow for integrated analyses in the monitoring. United Nations Statistics Division. https:// unstats.un.org/sdgs/files/Working-Group-ToR--Interlinkages.pdf UNSTATS (2021). Global indicator framework for the sustainable development goals and targets of the 2030 agenda for sustainable development. A/RES/71/313; E/CN.3/2018/2; E/CN.3/2019/2; E/CN.3/2020/2; E/CN.3/2021/2. https://unstats.un.org/sdgs/ Vincke, P. (1992). Multicriteria decision-aid. John Wiley & Sons. WSSD. (2002). Draft plan of implementation of the World Summit on sustainable development. A/CONF.199/L.1. https://sustainabledevelopment.un. org/milesstones/wssd

PART III

On Indicators

CHAPTER 8

Designing a Set of Indicators Addressing SDGs, Health and Urban National Policies

Coupling Between SDGs, Health and Urban National Policies Let us first take a closer look at indicators in Portugal associated with Goal 3, “God Health and Well-being”, and Goal 11 “Sustainable cities and communities”, using the most recent account by Statistics Portugal (INE, 2021), in its 4th edition. Then I will assess Goal 16, “Peace, Justice and Strong Institutions”, and Goal 17 “Partnerships for the Goals”, because these are the goals that assure policy integration and operationalise all other goals. Overall, the implementation of SDGs is being monitored using 152 indicators (out of the current total of 247, IAEG-SDGs 2016; UNSTATS, 2021) and the recent 4th edition analyses 44. Selection of indicators was performed according to the following criteria: usefulness to assess a given goal; relevance in the national context; recently updated information; analytic relevance; preference by new indicators featuring new information using as reference the last edition; and a balanced number of indicators considering all 17 goals. The report states the policy integration aspect of the 2030 Agenda and how to read available information. It is necessary to do a crossover between indicators associated with different goals to proper evaluate progress. Data used is available at Statistics Portugal and is supplemented by external sources. It is also stated that monitoring and

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 D. Soeiro, Cities, Health and Wellbeing, Sustainable Urban Futures, https://doi.org/10.1007/978-3-030-89348-4_8

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evaluation of SDGs is a dynamic process, and a constant work in progress is expected to have multiple updates. This statement can only be praised. According to goals, quantitatively, Statistics Portugal’s selection was performed as follows: Goal 3, 22 out of 28 indicators; Goal 11, 9 out of 14; Goal 16: 12 out of 27; Goal 17 10 out of 24. To date, no indicator was added to the UN’s list to validate the national context of implementing the 2030 Agenda. In that sense, the ultimate institutionalisation of the 17 goals in Portugal has yet to take place. The main question that arises concerns the qualitative aspect that supports the selection of 152 indicators. Who decided which indicators are relevant within the framework of each goal? We know that the responsibility of managing each goal was allocated to a specific Ministry. We also know that two Committees were created, the Committee for Interministerial Cooperation to foster partnerships and the Committee for Interministerial External Policy to articulate all Ministries. Were Ministries and Committees represented in meetings at Statistics Portugal to decide which are the most relevant indicators? Have these parties engaged in a dialogue that would allow them to propose their own indicators? Indicators’ selection and creation go beyond statistics. It is a political, economic and social affair that should be aligned according to each country’s priorities aiming at strengthening each realm addressed by each goal. The selection of indicators implies leadership, negotiation and the ability to motivate and encourage change for the better, aiming higher. Goal 3 indicators relate with a straight-up account of population affected by a given set of selected diseases, mortality, substance abuse treatment and consumption, vaccination and medical personnel available. These cover a significant part of what one may consider being basic health-related elements, which is unarguably critical to monitor. However, they again confirm the strict sense in which “health” is being taken, which has already been expanded in previous vital documents. As it was stated in Chapter 3, in alignment with World Health Organization, the European Commission (EC, 2017) since its 1st PHP, EU Health Programme 2003– 2007, adopted an all-encompassing sense of “health”, which includes physical, mental and well-being; WHO (2013) established four primary goals in its “Mental health action plan 2013 – 2020”, among them “Global target 4: 80% of countries will be routinely collecting and reporting at least a core set of mental health indicators every two years through their national health and social information systems ”. These observations highlight two gaps in the current set of indicators: there are no indicators

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that specifically monitor mental health and/or well-being. From this, it follows it would be important that some of the indicators associated with health would account for the population’s mental health and wellbeing materialising to the fullest the goal’s denomination “health and well-being”. In Portugal, there are currently nine indicators (out of 14) assessing Goal 11. However, a detailed comparative analysis with UN’s suggested indicators reveals a lower degree of sharpness in indicators 11.1.1; 11.3.1; 11.3.2; 11.4.1; 11.6.1. For example, UN’s 11.4.1 description is “Total per capita expenditure on the preservation, protection and conservation of all cultural and natural heritage, by source of funding (public, private), type of heritage (cultural, natural) and level of government (national, regional, and local/municipal)”. According to Statistics Portugal, two indicators allow to account for this: “Expenditures on cultural heritage of municipalities” and “Expenditures of municipalities on the protection of biodiversity and landscape, per inhabitant”. The level of detail is significantly different, allowing for a less refined account. We know the type of heritage but not the source of funding, and information about the level of government is limited to the municipal level. Some critical indicators suggested by the UN are not accounted for, like 11.2.1 that monitors access to transport, others that refer to urban resilience (11.5.1, 11.5.2 and 11.b.2) and others to access to safe open space for public use (11.7.1 and 11.7.2). This is incoherent with priorities that we have identified (see Chapter 4) at the national level. Carvalho (2016) identified mobility, connectivity and ecology as elements that should be prioritised to orient Portugal’s spatial and urban planning strategy. Also, PNPOT, 2020 (2020–2030), the national spatial and urban planning overarching agenda, the New Leipzig Charter (2020) and to some extent TAEU, 2030, all highlight sustainable green transport and a mobility strategy that is carbon–neutral, safe and multi-modal as a critical element to cities and climate change. In PNOPT, the word “resilience” occurs 58 times, yet no indicators are designated to monitor it, and no indicator measures city resilience. It would be necessary to clearly define which characteristics correspond to the concept in the Portuguese context. On that note, I quickly mention indicators identified as relevant to assess Goal 13 “Climate Action”, which are currently 2 (being a third one also featured in Goal 11): “Total greenhouse gas emissions per year” and “Contribution to the international 100bn USD commitment on climate-related expending”. Particularly concerning this goal,

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with such a high impact on so many other, it is urgent to detail relevant indicators. Goal 16, “Peace, Justice and Strong Institutions”, is of the utmost importance, particularly in the Portuguese context. In a moment, it will be clear why this is so but first, let us recall some previously stated facts. In Chapter 4, , I analysed national spatial and urban policies. The New Leipzig Charter (2020, p. 22) has the most detailed account of what good governance is, stressing the importance of “an integrated approach, participation and co-creation, multilevel governance and a place-based approach”. Aligned with this, Portuguese urban planning law specialists suggest that to make this change happen, bureaucracy should be significantly reduced and empowerment should be promoted at the municipal level by facilitating new alternatives to make it more proactive. However, the country’s feeble spatial and urban planning system dating back to 1864 consistently privileged municipalities and the local level. Furthermore, the most recent PNPOT, 2020 states that “production deficit and limited ability to access geographic information; insufficient cooperation culture and networks; “territorial culture deficit” are the most serious obstacles in spatial and urban planning (see Chapter 6). Local empowerment is claimed as a key solution. Yet Portugal has been favouring local power for over a century and still has a serious “territorial culture deficit”. As I stated previously, the mentality of living under an authoritarian state between 1933 and 1974 may have contributed to this but are we missing something? At this point, Goal 16 makes a significant contribution to clarifying the subject. Since the 2008 financial crisis, corruption values have continuously increased in Southern European countries such as Spain, Greece and Portugal (Kubbe, 2018). According to the Corruption Perceptions Index, Portugal’s rank between 2000 and 2020 significantly worsened (in 2000: 23rd rank; in 2010: 32nd rank; in 2015: 28th rank; in 2020: 33rd rank) (TI, 2021). The situation is known and documented for several decades now (Mendes & Camões, 2005). At the 2011 aggregation of parishes that reorganised municipalities (see Chapter 4), some perceived it as an opportunity to strengthen the local level (Teles, 2012); however, it is known that corruption at the local level is high. Moreover, in a study conducted by Stockemer and Calca (2013), it was concluded that in Portugal, turnout is several percentage points higher in “very corrupt” municipalities. According to Uslaner (2021, p. 435), levels of corruption in Portugal directly stem from a long legacy of inequality imposed by

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the pervasive influence of the Catholic Church for centuries that largely imposed its hierarchical leadership across society, including in the educational system. In the nineteenth century, both Portugal and Brazil ranked 42nd in education level (in 2010, Portugal ranked 32nd). Both before and during Portugal’s authoritarian regime, education was controlled by the Catholic Church. In 1844 a law was issued establishing mandatory education, but it was never enforced. In 1911, when the country transitioned from a monarchy to a republic, the law only mandated three years of schooling. Emphasising the role of inequality, using ownership of land as a measure, in 1868, only 20% of farms in Portugal were owned by families. Inequality breeds corruption by leading citizens to see the system stacked against them; creating dependency and a sense of pessimism in ordinary citizens, which encourages moral decay towards others; distorting fairness in courts, and other similar institutions, which citizens tend to perceive as protectors against those who have more influence (Uslaner, 2021, p. 428).1 These are the foundations of a study attesting Portugal’s above-average tolerance to corruption (Moriconi & Carvalho, 2016). Mouraz Lopes, Judge at Portugal’s Court of Auditors, recently denounced (RR, 2020) serious gaps to control public spending. Most legal corruption cases deal with corruption at the local level. He highlights the paradox that in 2011, at the time when parishes were reorganised, on the one hand, municipalities were asked to tighten expenses, having increased their financial responsibilities. Still, on the other hand, the General Inspection for Local Municipalities (Inspeção Geral das Autarquias Locais) that was in charge of monitoring spending was extinct. In practice, he adds, “existing mechanisms for internal fiscalization of money spending do not work […] barely existing a clear identification or coordination at public administration level” on who controls spending which could prevent corruption. Having conducted a detailed analysis of the situation, he states that it is necessary to clearly assume that municipalities are at high risk of misusing public money. The Judge concludes by claiming that the government’s recent 2017 Strategy to Combat Corruption through superbly drafted had no follow-up. The Public Ministry (Ministério Público) did not implement any mechanisms for collecting data, monitoring and evaluation. 1 Up until 2007, most full-time employees had four years of schooling (22.7%). For the first time, in 2020, most employees have a university degree (31.5%) (PORDATA 2021).

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In 2018 a comprehensive study assessing municipalities’ governance Tavares and Sousa (2018) concluded that the current system carries a high risk for facilitating favouring illicit trade and corruption. For example, between 2013 and 2016, only 39% out of many millions allocated to public procurement of goods, construction and services, were spent through public competitions. Recently it was reported (ZAP, 2021) that between June 2020 and June 2021, there was an increase of 4400 in personnel recruitment, the highest number on record ever.2 84% of new positions created in municipalities, parishes, municipal companies, associations, public institutions and inter-municipal communities were permanent contracts, allowing direct entry for public office, which provides a high-security level. At the national level, this type of contract in public administration accounted for 36%. Municipal companies represent the highest increase at the autarchic level, where employment increased more than 60%. Portugal has a stark territorial imbalance between the coastal area and the interior, with main economic activities and population in cities located by or close to its coastal area. It would be interesting to investigate up to which extent decades of a broken local governance system has contributed to the desertification of the interior. Back in 1998, the government conducted a referendum to ask if citizens if they agreed with going forward with a regionalisation process strengthening the regional level. At the time, citizens voted “no”. Current Prime Minister António Costa claims it is time to ask citizens again, proposing a regionalisation that strengthens existing CCDRs, reinforces Portugal’s relations with Spain and assures a significant budget increase for local institutions (Soares, 2021). Can regionalisation solve existing problems or add new ones? Is the system ready and mature enough to fully embrace regionalisation? It can be expected that a regional budget increase dissociated from a holistic, in-depth renovation at the governance level, complemented with serious legal control mechanisms, will result in resource waste and increased inequalities. Going back to Goal 16, indicators associated with targets 16.4; 16.5; 16.6; and 16.7 would allow us to identify these situations that are crucial 2 In September 2021 Portugal will hold autarchical elections. Data was provided by Síntese Estatística do Emprego Público (SIEP) in a quarterly publication issued by the General Directorate of Administration and Public Employment (Direcção-Geral da Administração e do Emprego Público-DGAEP) in the second trimester 2021.

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for the success of any area featured in the 2030 Agenda—or simply for the success of any area regardless of the agenda. Unfortunately, these targets are addressed by Statistics Portugal with one indicator only. Access to justice, transparency and corruption are not being monitored. This should be revised in future reports to facilitate implementing the aforementioned 2017 Strategy to Combat Corruption created by the Public Ministry. It is demonstrated that the current institutional governance system, particularly at the municipal and parish level, has high corruption levels. How to make this information compatible with EU and national recommendations to promote the empowerment of local authorities and work towards “an integrated approach, participation and co-creation, multilevel governance and a place-based approach”? From this situation, we should not infer that all those working in autarchical institutions have bad intent. On the one hand, finding new strategies to reward and encourage those who show leadership qualities is needed, promoting and facilitating their initiative and motivation to provide high-quality public service.3 On the other hand, it is urgent to make it hard for those who show bad intent to go through with it. Because it has not accounted for the implementation of existing legal mechanisms, the current system does not effectively prevent corruption, making it, subsequently, challenging to hold those responsible accountable. This state of affairs is what PNPOT identifies under the expression “territorial culture deficit”, one of the most pervasive obstacles to a successful implementation of spatial and urban policies.4 How to overcome this? Can partnerships be the way out? Goal 17 “Partnerships for the Goals”, is the one that features more targets having 24 indicators. Though all targets are essential, considering the main subject of this book that privileges intersectoral and multilevel elements, targets that refer to systemic issues (17.13–17.19) are vital.

3 On different types of municipal leadership, see Teles (2014). 4 Among several examples: (1) when compared to the previous year, in the first quarter

in 2021, there was an increase of 22,6% of residential licenses issued by municipalities in the country authorising the construction of new residences; and a 13,2% increase in residential rehabilitation (Sapo 2021); (2) only 43% of municipalities and parishes have reported to the National Commission for Data protection the identity of who is in charge of data protection (JE, 2021).

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These refer to policy and institutional coherence; multi-stakeholder partnerships; and data, monitoring and accountability. It would be suitable to identify strategic indicators adapted to the Portuguese context to keep track of these components. Providing a detailed description of what is at stake in partnerships, in the specific context of local governance and inter-municipal cooperation, Teles (2016, p. 86) concludes that “cooperation is much more than a handshake”, involving “power and democracy, scale and territory, governance and administrative tools, rules and laws, organisational culture and economic efficiency, success and failure”.

Governance, Administration and Management Challenges: Process (Efficient, Outputs) and System (Effective, Outcomes) Administrative processes put in place allow us to assess how efficient those processes are. This means: time-wise, do processes allow for an easy flow from decision-making to implementation, making the most of available resources, presenting pre-established results? Carvalho and Oliveira (2016, p. 9) have argued that part of the answer to changing spatial planning culture is significantly reducing bureaucracy. Excessive bureaucracy is a symptom of the system. Like in many other countries, Portugal experiences a sense of distance between citizens and administration. According to Teles (2020, p. 439), this is reinforced “by the systematic institutionalisation of a hegemonic paradigm based on the prevalence of administrative law particularly focused on formal issues”. Alluding to the impact of several decades of an authoritarian government, Teles additionally claims that this excessive focus on formal issues stems from a prevailing top-down approach, which is not aligned with current “pillars of parliamentary representative, democracy, where models of delegation are preferred over total control of public administration from the political sphere”. The Portuguese administrative system has, therefore, a long tradition of a solid and concentrated administration. This severely hinders the design and implementation of multilevel and intersectoral policies because the system lacks flexibility and adaptability. Inevitably, all decision-making is constantly forwarded to the top, leaving most of the structure in a

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state of paralysis. This generates a sense of disinterest and unaccountability in lower levels and adds a never-ending number of tasks pending decision-making in upper levels (from the minute to the highly relevant). A robust system in a democratic context is a system that is open, flexible and adaptable featuring mechanisms of transparency, justice and accountability. These characteristics are fundamental to assure a successful territorial cohesion—and consequently, a successful regional policy, cohesion policy and economic growth. How to implement an innovative, place-based territorial approach in the current Portuguese context? To trace a way forward, it is essential to make a diagnosis as accurate as possible of the current situation. Denial, cover-up and manipulation of components is not a strategy that leads to success. Establishing high standards, being proud of what has been accomplished and openly affirm which are the priorities that allow us to become better is. In the realm of spatial and urban planning, according to the organigram provided by PNPOT (2019, p. 318) that orients the period between 2020 and 2030, this area concerns the government (mainland), Azores and Madeira governments and in particular, the Ministry for Environment. Main coordination is allocated to Directorate-General for Territory (DGT) and regional coordination to CCDR (mainland), Madeira and Azores. The Observatory for Spatial and Urban Planning (REOT), integrated into DGT, is responsible for monitoring and evaluation. In 2020, a Resolution issued by the Council of Ministers (48/2020, 24 June) determined that the governance model for implementing PNPOT should be operationalised by the Intersectoral Forum, specifically created to do so (PNPOT-FI, 2020). In 2015, the Strategy Sustainable Cities 2020 (Ministers Council Resolution 61/2015, 16 July) was jointly issued by the Ministry for Environment, Spatial Planning and Energy and DGT featuring its goals for 2020 in alignment with PNPOT (DGT, 2015). It is one of the most comprehensive documents providing an informed diagnosis featuring a detailed analysis of main obstacles to address to achieve sustainable cities. It validates and acknowledges at a political level several items that comprise the scenario previously diagnosed in research. Concerning governance, it affirms that Portugal was not still able to find the most adequate governance system that allows for citizen participation, having maintained or regressed according to its position in World Bank’s governance indicators. It also acknowledges that EU funding should promote

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multilevel governance, intersectoral governance and the creation of cooperation/network (pp. 97, 98). Annex II of this document provides a very extensive and highly detailed survey of available financing to attain specific goals (smart and competitiveness; sustainability and efficiency; inclusion and human capital; territorialisation and governance). Being a valuable document representing an advancement that should be praised, it privileges financing strategies as a way to go forward instead of proposing a renewed governance system with a new institutional approach that assures transparency, justice and accountability more in accordance with the country’s democratic system. Without an in-depth reform at the system level and corresponding governance mechanisms, financing will not be fully effective in the long term. The most powerful instrument to produce long-lasting outputs is at the governance level. If that is accomplished, financial resources will then be used with minimal waste. Hopefully, the new strategy from 2021 onwards will privilege this. When it comes to health and mental health in particular, both the National Health Plan (2012–2016) and the first National Plan for Mental Health (2007–2016) were extended up until 2020. As it was demonstrated in Chapter 3, EU recommendations include intersectoral cooperation as an effective strategy to attain health benefits while cutting costs. Furthermore, future health plans will address more extensively mental health. As for the first National Plan for Mental Health, in complete alignment with existing legislation and sagaciously detailed, we can only hope that a more substantial investment in governance strategies will allow for a more successful implementation strategy and effectiveness. The health indicators featured by Statistics Portugal are a good opportunity to include the many recommendations at the national and international level, including mental health and well-being indicators. At the institutional level, since Portugal’s first democratic government (1976), the realm of health and the realm of spatial and urban planning have two very different approaches. Health has a straightforward story to tell. Between the first and sixth governments (1976–1981), it was included in the Ministry for Social Affairs, featuring a State Secretariat for Health. Between 1981 and 1983 (seventh and eighth governments), health was handled by the Ministry for Quality of Life. From the ninth government onwards, starting in 1983, the Ministry of Health was created, and it has existed up until now in all succeeding governments. A Directorate-General for Health (DGS) exists since 1899, being responsible for regulating and coordinating activities to promote health

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and prevent disease; create and implement health plans; to coordinate international relations with the Ministry of Health. The role of spatial and urban planning in governments overtime,5 it is challenging because it had little or no institutional stability (see Fig. 8.1). Ministers for Urban Matters in Portugal between 1976 and 2020. Elaborated by the author). Almost all kinds of approaches took place. Spatial planning was jointly addressed with urbanism; not jointly addressed; it had its own Ministry; it was a Secretariat and not a Ministry; it was addressed along with the environment and then not etc. Closely related areas, like “regional development”, were assigned its first Secretariat in 1999, and it was maintained until 2009; it was again rescued since 2015. “Energy” was explicitly mentioned for the first time in 2011 associated with the Ministry for Environment, Spatial Planning and Energy. It has been so until 2019 when it was integrated into a Secretariat. The word “nature” was featured for the first time in 2011 in the Secretariat for Spatial Planning and Nature Conservation. The Secretariat has continued to exist up until now. In 2019 it was created the first Ministry for Territorial Cohesion. Institutionally, spatial and urban planning (and adjacent areas) have a volatile role within the system. This instability has inevitably contributed to a lack of endurance, cohesion and sustained vision concerning the country’s territorial approach. The most enduring institution in spatial planning has been the current Directorate-General for Territory (DGT), integrated into the Ministry for Environment, having administrative autonomy (Decree n.7/2012, 17 January; Decree n.119/2013, 21 August; Regulation n.30/2012, 13 March). It is possible to trace its existence (under many different names) since 1788, and traditionally its main aim has been to produce a detailed and updated cartographic survey of the territory (DGT, 2021). Since 2012, adding to this, DGT is responsible for implementing spatial and urban planning public policies aiming at territorial cohesion, according to good practices. At the institutional level, though elected governments are the ones who establish a vision for their respective realms, it is the DirectorateGeneral for Territory that is responsible for the implementation of policies 5 Portugal elects a new government every four years. Over time it has happened that a given government was overthrown, and new elections were held. Holding its first democratic election in 1976, Portugal is now in its XXII Government since 2019.

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Period/Constitutional Government 1976-1978 – I Mário Soares

Name

Sub-Secretaries

Ministers

Minister for Housing, Urbanism and Construction; Minister for Public Works; Minister for Agriculture and Fisheries; President of the Council of Ministers

Eduardo Pereira; João Almeida Pina; António Lopes Cardoso and António Barreto

1978 – II Mário Soares

Minister for Housing and Public Works; Minister for Transportation and Communications; Minister for Agriculture and Fisheries; Minister for Administrative Reform Minister for Housing and Public Works; Minister for Transportation and Communications; Minister for Agriculture and Fisheries

State Secretary for Civil Engineering – Armando Esteves Pereira; State Subsecretary for Housing, Urbanism and Construction – Albérico Santos Machado. Both replaced in 1977 by State Subsecretary for Housing, Urbanism and Construction – Albérico Santos Machado // State Secretary for the Environment – Manuel Gomes Guerreiro State Secretary for Public Works – João Porto; State Secretary for Housing – Carlos Ferro Gomes; State Secretary for Physical Planning and the Environment – José Gomes Fernandes State Secretary for Public Works – Mário de Azevedo; State Secretary for Housing – José Augusto Ramos; State Secretary for Physical Planning, Water Resources and the Environment – Baltazar Morais Barroco

João Almeida Pina; Amílcar Marques; Apolinário Vaz Portugal

1978 – III CV António Nobre da Costa

António Sousa Gomes; Manuel Ferreira Lima; Luís Saias; Rui Pena

1978-1979 – IV Carlos Alberto da Mora Pinto 1979-1980 – V Maria de Lurdes Pintasilgo 1980-1981 – VI Fernando Sá Carneiro/ Diogo Freitas do Amaral 1981 – VII Francisco Pinto Balsemão

Minister for Housing and Public Works; Minister for Transportation and Communications; Minister for Agriculture and Fisheries Minister for Housing and Public Works; Minister for Transportation and Communications; Minister for Agriculture and Fisheries Minister for Housing and Public Works; Minister for Transportation and Communications; Minister for Agriculture and Fisheries; President of the Council of Ministers Minister for Housing and Public Works; Minister for Transportation and Communications; Minister for Agriculture and Fisheries; Minister for Administrative Reform; Minister for Quality of Life

State Secretary for Public Works – Mário de Azevedo; State Secretary for Housing – José Augusto Ramos; State Secretary Physical Planning, Water Resources and Environment – Baltazar Morais Barroco State Secretary for Public Works – Agnelo Crespo; State Secretary for Housing – Cândido Ferreira; State Secretary for Urbanism and the Environement – José Palma da Silva Bruschy State Secretary for Public Works – Carlos Vaz Pardal; State Secretary for Housing and Urbanism – Casimiro Pires// State Secretary Physical Planning and Environment – Ilídio de Araújo and Margarida Borges de Carvalho State Secretary for Public Works – Carlos Vaz Pardal; State Secretary for Housing and Urbanism – Casimiro Pires

João Almeida Pina; José Marques da Costa; Apolinário Vaz Portugal

1981-1983 – VIII Francisco Pinto Balsemão

Minister for Housing, Public Works and Transportation; Minister for Industry, Energy and Exports; Minister for Agriculture, Commerce and Fisheries; Minister for Justice and Administrative Reform; Minister for State and Quality of Life Minister for Social Equipment; Minister for Maritime Affairs; Minister for Agriculture, Forests and Food and Minister for Agriculture; Minister for Industry and Energy; Minister for Quality of Life

State Secretary for Housing and Urbanism – Carlos Mascarenhas de Almeida; State Secretary for Public Works – Eugénio Nobre

José Viana Baptista; Ricardo Bayão Horta; Basílio Horta; José Ménéres Pimentel; Gonçalo Ribeiro Telles

State Secretary for Communications – Raúl Junqueiro; State Secretary for Public Works – Eugénio Nobre; State Secretary for Transportation – Francisco Murteira Nabo; State Secretary for Housing and Urbanism – Fernando Gomes// State Secretary for the Environment – Carlos Pimenta and Eduardo Oliveira Fernandes State Secretary for Local Administration and Spatial Planning – José Nunes Liberato; State Secretary for the Environment and Natural Resources – Carlos Pimenta; State Secretary for Planning and Regional Development – José Silva Peneda; State Secretary for Plan and State Administration – Eduardo Arantes de Oliveira State Secretary for Local Administration and Spatial Planning – José Nunes Liberato; State Secretary for Planning and Regional Development – Isabel Mota

João Rosado Correia, Carlos Melancia; Carlos Melancia José de Almeida Serra; Manuel Soares Costa and Álvaro Barreto; José Veiga Simão; António Capucho and Francisco Sousa Tavares Luís Valente de Oliveira; João Maria de Oliveira Martins; Álvaro Barreto

1983-1985 – IX Mário Soares

1985-1987 – X Aníbal Cavaco Silva

Minister for Planning and Territorial Administration; Minister for Public Works, Transportation and Communications; Minister for Agriculture, Fisheries and Food

1987-1991 – XI Aníbal Cavaco Silva

Minister for Planning and Territorial Administration; Minister for Housing, Public Works and Transportation; Minister for Agriculture, Fisheries and Food; Minister for Industry and Energy; Minister for Environment and Natural Resources Minister for Planning and Territorial Administration; Minister for Public Works, Transportation and Communications; Minister for Agriculture; Minister for Maritime Affairs; Minister for Industry and Energy; Minister for Environment and Natural Resources Minister for Planning and Territorial Administration and Minister for Social Equipment, replaced in 1996 by Minister for Equipment, Planning and Territorial Administration; Minister for Agriculture, Rural Development and Fisheries; Ministry for Environment

1991-1995 – XII Aníbal Cavaco Silva

1995-1999 – XIII António Guterres

1999-2002 – XIV António Guterres 2002-2004 – XV José Manuel Barroso 2004-2005 – XVI Pedro Santana Lopes

2005-2009 – XVII José Sócrates

2009-2011 – XVIII José Sócrates 2011-2015 – XIX Pedro Passos Coelho

Mário de Azevedo; Frederico Monteiro da Silva; Joaquim Lourenço João Porto; José Carlos Viana Baptista; António Cardoso e Cunha Luís Barbosa; José Viana Baptista; António Cardoso e Cunha; Eusébio Marques de Carvalho; Augusto Ferreira do Amaral and João Vaz Serra de Moura

Luís Valente de Oliveira; João Maria de Oliveira Martins and Joaquim Ferreira do Amaral; Álvaro Barreto and Arlindo Cunha; Luís Mira Amaral; Fernando Real and Carlos Borrego

State Secretary for Local Administration and Spatial Planning – João Pereira Reis; State Secretary for Planning and Regional Development – Isabel Mota

Luís Valente de Oliveira; Joaquim Ferreira do Amaral; Arlindo Cunha and António Duarte Silva; Eduardo Azevedo Soares and António Silva Duarte; Luís Mira Amaral; Teresa Gouveia

State Secretary for Local Administration and Spatial Planning – José Augusto Carvalho; State Secretary for Regional Development – Adriano Pimpão

João Cravinho and Henrique Constantino, Francisco Murteira Nabo – João Cravinho; Fernando Gomes da Silva; Luís Capoulas Santos; Elisa Ferreira

Minister for Environment and Spatial Planning; Minister for Social Equipment; Minister for Agriculture, Rural Development and Fisheries; Minister for Planning Minister for Cities, Spatial Planning and Environment; Minister for Public Works, Transportation and Housing; Minister for Agriculture, Rural Development and Fisheries Minister for Cities, Local Administration, Housing and Regional Development; Minister for Environment and Spatial Planning; Minister for Public Works, Transportation and Communications; Minister for State, National Defense and Maritime Affairs; Minister for Agriculture, Fisheries and Forests Minister for Environment, Spatial Planning and Regional Development; Minister for Public Works, Transportation and Communications; Minister for Agriculture, Rural Development and Fisheries

State Secretary for Spatial Planning and Nature Conservation – Pedro Silva Pereira; State Secretary for the Environment – Rui Nobre Gonçalves; State Secretary for Local Administration – José Augusto de Carvalho State Secretary for the Environment and Spatial Planning –Artur da Rosa Pires; State Secretary for Local Administration – Paulo Pereira Coelho; Adjunct State Secretary and Regional Development – Hermínia Cabral State Secretary for Local Administration – José Cesário; State Secretary for Regional Development – José Eduardo Martins // Adjunct State Secretary for the Minister of Environment and Spatial Planning – Jorge Moreira da Silva

José Sócrates; Jorge Coelho, Eduardo Ferro Rodrigues, José Sócrates; Luís Capoulas Santos; Elisa Ferreira

State Secretary for Spatial Planning – João Ferrão; State Secretary for the Environment – Humberto Rosa; State Secretary for Regional Development – Rui Baleiras

Francisco Nunes Correia; Mário Lino; Jaime Silva

Minister for Environment and Spatial Planning; Minister for Public Works, Transportation and Communications; Minister for Agriculture, Rural Development and Fisheries Minister for Agriculture, Maritime Affairs, Environment and Spatial Planning replaced in 2013 by Minister for Agriculture and Maritime Affairs and Minister for Environment, Spatial Planning and

State Secretary for Spatial Planning – Fernanda Carmo; State Secretary for the Environment – Humberto Rosa

Dulce Pássaro; António Mendonça; António Serrano

State Secretary for Spatial Planning and Nature Conservation – Miguel de Castro Neto

Assunção Cristas; Assunção Cristas and Jorge Moreira da Silva; Miguel Poiares Maduro

Fig. 8.1 The role of spatial and urban planning

Arlindo Cunha; António Carmona Rodrigues; Armando Sevinate Pinto José Luís Arnaut; Luis Nobre Guedes; António Mexia; Paulo Portas; Carlos Costa Neves

8

2015 – XX Pedro Passos Coelho 2015-2019 – XXI António Costa

2019- – XXII António Costa

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Energy; since 2013, Minister Adjunct and Regional Development Minister for Environment, Spatial Planning and Energy; Minister for Presidency and Regional Development; Minister for Agriculture and Maritime Affairs Minister for Planning and Infrastructures (extinct in 2019); Minister for Planning (created in 2019); Minister for Infrastructures and Housing (created in 2019); Minister for the Environment renamed in 2018 as Minister for the Environment and Energy Transition; Minister for Agriculture, Forests and Rural Development Minister for Territorial Cohesion; Minister for the Environment and Climate Action; Minister for Infrastructures and Housing; Minister for Agriculture; Minister for Maritime Affairs

149

State Secretary for Spatial Planning and Nature Conservation – Miguel de Castro Neto

Jorge Moreira da Silva; Luís Marques Guedes; Assunção Cristas

State Secretary for Regional Development – Maria do Céu Antunes // State Secretary for Spatial Planning and Nature Conservation – Célia Ramos; Adjunct State Secretary and State Secretary for Mobility – José Fernando Gomes Mendes; State Secretary for the Environment – Carlos Martins and João Ataíde

Pedro Marques; Nelson de Souza; João Pedro Matos Fernandes; Luís Capoulas Santos

Adjunct State Secretary for Regional Development – Carlos Miguel; State Secretary for Interior Valorisation – Isabel Ferreira // State Secretary for Nature Conservation, Forests and Spatial Planning – João Paulo Catarino; State Secretary for the Environment – Inês dos Santos Costa; State Secretary for Mobility – Eduardo Pinheiro; Adjunct State Secretary and State Secretary for Energy – João Galamba

Ana Abrunhosa; João Pedro Matos Fernandes; Pedro Nunes Santos; Maria do Céu Antunes; Ricardo Serrão Santos

Main source: https://www.portugal.gov.pt/pt/gc21/governo/governos-anteriores

Fig. 8.1 (continued)

on the ground having the unquestionable continuity factor. The recently created Intersectoral Forum in the context of PNPOT, 2020, coordinated by the DGT under the responsibility of the government, confirms this (PNPOT-FI, 2020). As a young democracy, Portugal had an unaccounted succession of governments (since 1999, only three elected governments completed their four-year mandate). This leads to an added difficulty in accessing data that allows sustained monitoring and evaluation processes. Also, because the strategic vision changes frequently, the operational level is not supported by an intent other than administrative procedures. As stated before, these are characterised by strong centralisation, showing adaptation and flexibility difficulties. Ultimately, instability blocks the administrative system from fully transitioning to a democracy. Politically the country is a democracy, but institutionally, at the system level, the structure is still more representative of the many decades of an authoritarian system, characterised by heavy procedures and bureaucracy. First and foremost, it is expected that the Portuguese governance systems become more open and flexible, implementing existing legislation on the ground and, above all, enforcing active measures to promote mechanisms that favour just and transparent institutions. Only then, in such context, will multilevel and intersectoral policies make sense. Both health and spatial and urban planning Directorate-Generals are, respectively, key to diagnosing main governance obstacles that hinder implementation, being valuable partners to suggest effective monitoring and evaluation strategies. At an operational level, the most stable institutions in these realms could be perceived as a good start to streamline procedures and bureaucracy. Otherwise, whichever the vision implemented by elected Ministers will go stale. Also, because it deals with the operational level, the Directorate-General is the right place to encourage

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the design and implement multilevel, intersectoral strategies and cooperation strategies. These institutions need to mature towards a democracy, from a set of administrative procedures to a cooperative and inclusive network system. In that sense, along with current Miniseries, the health and spatial and urban planning Directorate-Generals (DGS and DGT) can significantly contribute to identifying and creating indicators. This would allow for a more sustained and potentially effective monitoring and evaluation, ensuring that Portugal goes beyond compliance with the 2030 Agenda, helping to create accountability and transparency mechanisms supported by decentralisation and shared decision-making processes.

Proposal of a Set of Indicators Addressing SDGs, Health and Urban National Policies The selection of indicators addressing SDGs in health and spatial and urban policies should imply a cooperation process, and it is important that they are negotiated outcomes. First, it is necessary that all parties agree upon the diagnosis, then options need to be discussed according to established priorities, then indicators are either selected or created. The 2030 Agenda is effective up until 2030, and therefore in several years to come, indicators can be progressively added. The main idea is that tailored place-based approaches require tailored place-based indicators. According to EU’s and Portugal future orientations, it is expected that municipalities and regions will have added responsibilities and an increased budget in upcoming years. In that sense, responsibilities should include collecting data, using it to formulate their own policies and also sharing it with Statistics Portugal. Particularly in mental health, for some decades now, the lack of data is constantly mentioned. If there is no data, there are two immediate consequences: the realm, and its problems, are politically invisible, and though it may be acknowledged that something would need to change, there is not a clear idea on where to start and which are the priorities being hard to formulate concrete public policies since the state of the art of the situation is unknown. This also makes it difficult to assess whether progress is being made when any public policy is implemented. For example, it would be helpful if the National Health Service’s website that features

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151

a large database would include as keyword “mental health” or “psychiatry” to facilitate access to information. Perhaps this would encourage that more data would be collected. Indicators should be able to provide access to real-world data, and only then the information can be used to create models and make predictions. The more reliable the real-world data is, the more robust can models be. What makes little sense is to model data with low-quality real-world data or based on fictional data. To encourage a dialogue between health policies and spatial and urban policies and based on the extensive information previously reviewed, I suggest some indicators that could be used as a starting point of discussion by Statistics Portugal. Some rely predominantly on administrative practices, others on technology (smart city) and some on both. Most are not yet available and would need to be agreed upon with institutions that would commit to present information regularly: 1) SDG 3: Arrears—data provided by National Health Service (SNS); 2) SDG 3: Number of mental health consultations, including psychiatry and psychology, both in public and private sector—data provided by the National Health Service (SNS); Central Administration of the Health Services (ACSS) and INE. 3) SDG 3: Access to a general hospital that provides mental health services by parish (in km)—data provided by the DirectorateGeneral for Territory (DGT). 4) SDG 3: Number of psychiatrists, psychiatric nurses and psychologists, per municipality—data provided by SNS and ACSS, Order of Physicians, Order of Nurses and Order of Portuguese Psychologists. 5) SDG 3: Access to public community-based infrastructure that provides mental health services by parish (in km) DirectorateGeneral for Territory (DGT). 6) SDG 11—Shading zones in slow mobility areas, natural or artificial and in proportion to the parishes and municipality’s area—data provided by each municipality. 7) SDG 11: Number of playgrounds for children below and above 1010m2, by municipality—data provided by each municipality. 8) SDG 11: Access to green and blue structures within the urban agglomeration, from each parish (in metres)—data provided by each municipality.

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9) SDG 11: How many urban parks (green areas, fitness equipment, jogging tracks and sports courts), by size; pocket parks (up until 1010m2); medium-size parks and large parks—data provided by each municipality. 10) SDG 11: Proportion (%) of green and blue area considering both the area of the parish and the area of the municipality—data provided by each municipality. 11) SDG 11: Noise and temperature daily records (using strategically placed sensors across parishes)—data provided by each municipality.

References Carvalho, J. (2016). Matriz estruturante de territórios urbanos emergentes. In J. Carvalho & F. P. Oliveira (Eds.), Classificação do solo no novo quadro legal (pp. 59–90). Almedina. Carvalho, J., & Oliveira, F. P. (2016). Classificação, reclassificação e qualificação do solo no novo quadro legal. In J. Carvalho & F. P. Oliveira (Eds.), Classificação do solo no novo quadro legal (pp. 9–36). Almedina. DGT. (2015). Cidades Sustentáveis 2020. Direcção-Geral do Território e Ministério do Ambiente, Ordenamento do território e Energia. https:// www.dgterritorio.gov.pt/sites/default/files/ficheiros-cidades/Cidades_Sust entaveis2020.pdf DGT. (2021). Cronologia Histórica da Direcção-Geral do Território. DirecçãoGeral do Território Website. https://www.dgterritorio.gov.pt/dgt/historia-pat rimonio/cronologia-historica?language=en EC. European Commission. (2017). Mid-term evaluation of the 3rd Health programme 2014–2020 under Regulation (EU) No 282/2014 on the establishment of a third programme of Union action in the field of health (2014– 2020). SWD(2017) 333 final, 11.10.2017. https://ec.europa.eu/health/ sites/health/files/programme/docs/2014-2020_evaluation_cswdexe_en.pdf INE. Instituto Nacional de Estatística. (2021). Objetivos de Desenvolvimento Sustentável - Agenda 2030. Indicadores para Portugal: 2010–2020. https:// www.ine.pt/xurl/pub/280981585 JE. Jornal Económico. (2021, June 22). Mais de metade das autarquias viola lei de proteção de dados. Jornal Económico. https://jornaleconomico.sapo. pt/noticias/mais-de-metade-das-autarquias-viola-lei-de-protecao-de-dados753529

8

DESIGNING A SET OF INDICATORS ADDRESSING SDGS …

153

Kubbe, I. (2018). Europe’s “democratic culture” in the fight against corruption. Crime Law Soc Change, 70, 217–240. https://doi.org/10.1007/s10 611-017-9728-9 Mendes, S. M., & Camões, P. J. (2005). Corruption and political institutions in Portugal: an exploratory analysis. Annual Meeting of the European Consortium for Political Research, 3, Budapeste. http://hdl.handle.net/ 1822/3802 Moriconi, M., & Carvalho, T. (2016). Social classes and tolerance to corruption in Portugal: What is the relationship?. Portuguese Journal of Social Science, 15(2), 299–318(20). https://doi.org/10.1386/pjss.15.2.299_1 PNPOT 2020. (2019). Programa Nacional da Política do Ordenamento do Território (PNPOT). Lei n.o 99/2019 de 5 de setembro Diário da República n.o 170/2019. Direcção-Geral do Território. https://pnpot.dgterritorio.pt/ pnpot PNPOT-FI. (2020). Fórum Intersetorial. Programa Nacional da Política do Ordenamento do Território (PNPOT). Direcção-Geral do Território. Resolução do Conselho de Ministros 48/2020, de 24 de junho. https:// pnpot.dgterritorio.gov.pt/pnpot/governacao/forum-intersetorial PORDATA. (2021). Trabalhadores por conta de outrem: total e por nível de escolaridade completo (%.). https://www.pordata.pt/Portugal/Trabalhad ores+por+conta+de+outrem+total+e+por+n%c3%advel+de+escolaridade+com pleto+(percentagem)-2253 RR. Rádio Renascença. (2020, November 27). Portugal continua a “falhar no controlo dos dinheiros públicos”, sobretudo das autarquias. Rádio Renascença. https://rr.sapo.pt/noticia/pais/2020/11/27/portugal-con tinua-a-falhar-no-controlo-dos-dinheiros-publicos-sobretudo-das-autarquias/ 216443/ Sapo. (2021, June 28). Licenças habitacionais emitidas pelas autarquias sobem 20,6%. Sapo Notícias. https://casa.sapo.pt/noticias/licencas-habitacionaisemitidas-pelas-autarquias-sobem-20,6/?id=28770 Soares, Carla. (2021, June 2). Costa espera que “país diga sim à regionalização”. Jornal de Notícias. https://www.jn.pt/nacional/costa-espera-que-paisdiga-que-sim-a-regionalizacao-13797671.html Stockemer, D., & Calca, P. (2013). Corruption and turnout in Portugal—A municipal level study. Crime Law Soc Change, 60, 535–548. https://doi.org/ 10.1007/s10611-013-9481-7 TAEU 2030. (2020). Territorial Agenda for the European Union 2030 (1 December, Germany). Informal meeting of Ministers responsible for spatial planning, territorial development and/or territorial cohesion https://territori alagenda.eu/wp-content/uploads/TA2030_jun2021_en.pdf

154

D. SOEIRO

Tavares, A. F., & Sousa, L. de (Eds.) (2018). Qualidade da Governação Local em Portugal. Fundação Francisco Manuel dos Santos. https://www.ffms.pt/pub licacoes/grupo-estudos/2819/qualidade-da-governacao-local-em-portugal Teles, F. (2012). Beyond paternalism towards social capital: Local governance reform in Portugal. International Journal of Public Administration, 35(13), 864–872. https://doi.org/10.1080/01900692.2012.684194 Teles, F. (2014). Facilitative mayors in complex environments: Why political will matters. Local Government Studies, 40(5), 809–829. https://doi.org/10. 1080/03003930.2013.801835 Teles, F. (2016). Local governance and inter-municipal cooperation. Palgrave. https://doi.org/10.1057/9781137445742.0009 Teles, F. (2020). Public Administration in Portugal. In G. Bouckaert & W. Jann (Eds.), European perspectives for public administration: The way forward (pp. 439–452). Leuven University Press. TI. Transparency International. (2021). Official Website. https://www.transpare ncy.org/en/countries/portugal UNSTATS. (2021). Global indicator framework for the Sustainable Development Goals and targets of the 2030 Agenda for Sustainable Development. A/RES/71/313; E/CN.3/2018/2; E/CN.3/2019/2; E/CN.3/2020/2; E/CN.3/2021/2. https://unstats.un.org/sdgs/ Uslaner, E. M. (2021). Inequality, education and corruption. In A. Bågenholm, M. Bauhr, M. Grimes, & B. Rothstein (Eds.), The Oxford Handbook of the Quality of Government (pp. 427–446). Oxford University Press. WHO. (2013). Mental health action plan 2013–2020. World Health Organization Website. https://www.who.int/publications/i/item/9789241506021 XXI Governo, República Portuguesa. (2021). Governos anteriores. https:// www.portugal.gov.pt/pt/gc21/governo/governos-anteriores ZAP. (2021, August 18). Nunca se registaram tantas contratações nas autarquias (e 84% entraram nos quadros). ZAP AEIOU . https://zap.aeiou.pt/contratac oes-autarquias-quadros-425532

CHAPTER 9

Conclusion

History and legacies matter when it comes to understanding institutional capacity. This is why the 2030 Agenda is both challenging and an excellent opportunity to reflect on and renew current governance systems. This book is as much about encouraging multilevel and multisectoral public policies in health, and spatial and urban policies as it is about governance. Globalisation and EU influence in national public policy: Each country’s politics is an international affair, and each country’s governance system is increasingly transnational. This adds upper levels to the vertical axis of governance to the previous national, regional and local ones. The European Union and, to some extent, the United Nations, having for the first time intensely negotiated its outcomes that resulted in the 2030 Agenda, are also key stakeholders to be included in each EU country’s governance vertical axis. Constraints on public policy, social and cultural factors: To Portugal, this is particularly challenging since the country lived under an authoritarian system between 1933 and 1974, and since then, it has been struggling to decentralise and democratise its institutions and public administration. The system successfully served an authoritarian system, but since democracy was proclaimed, it has shown high resistance levels to adapt to a multilevel decision-making organisation. This manifested in a disconnection between the local and national levels, where regional mechanisms are almost residual and unable to bridge both. In 1986 Portugal © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 D. Soeiro, Cities, Health and Wellbeing, Sustainable Urban Futures, https://doi.org/10.1007/978-3-030-89348-4_9

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became an EU Member State adding complexity to a previously feeble governance system. The priority was to align the national level with the EU. However, the internal articulation of national, regional and local levels has been a matter consistently postponed. This also impacts the ability to cooperate and establish networks, hindering the capacity to design intersectoral policies. Formulating policy/strategic direction in health and spatial and urban planning: These two realms are the focus of this book. However, the governance aspect would be relevant to frame whichever realms. This is why along with Goal 3 (Health) and Goal 11 (Cities), I address Goal 16 (Institutions) and Goal 17 (Partnerships). A sectoral analysis of health in the context of the EU lead us to conclude that the 3rd EU Health Programme 2014–2020, issued by the European Commission as a Regulation, represented a significant step towards a cohesive European approach. Significantly, it specifically addressed mental health, affirming its alignment with the World Health Organization by declaring an allencompassing sense of “health” (physical, mental and well-being). The most recent EU4Health Programme 2021–2027 significantly expands the scope of health and specifically calls for action in mental health. The impact of EU policies in the realm of health was analysed using country recommendations to Portugal in the context of the European Semester. Among several suggestions, it was particularly relevant its encouragement of intersectoral strategies as a way to reduce costs, having been noticeable a high resistance, system-wise, to do so. At the national level, in 2004, the first National Health Plan (2004– 2010) was issued. More recently, agenda-setting documents are the National Health Plan (2012–2016) and the first National Plan for Mental Health (2007–2016), both extended until 2020. The first thing to observe is that mental health is not included in the national plan. Perhaps this is so because the launching dates did not match initially or perhaps because mental health was being seriously addressed for the first time, and it needed a more in-depth approach justifying an autonomous plan. Other reasons may include, mental health has different needs than general health, it has been a neglected area within the health system for a long time, and for several decades now, Portugal has been living under a transition phase where, following worldwide trends, aims at deinstitutionalise, providing a more integrated community-based approach. Nevertheless,

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the process has been slow, having many obstacles. Among them, at implementation level due to lack of flow and flexibility at governance level and incentives. In spatial and urban planning, I have demonstrated that over time, the EU’s cohesion policy, supported by a regional policy that aimed to reduce inequalities among regions from its foundations, has slowly been adopted as its gravitational centre, cities and urban agglomerations. Favouring a place-based approach, cities across Europe are now perceived as the leading economic drive that promotes growth and is able to balance inequality among regions. Does this mean we are going towards a uniform spatial planning European policy? I present that debate in Chapter 4, but whichever side we take, it is evident that spatial and urban planning at a national level are more important than ever in a context of European transnational governance. Portugal decades-long struggles within this area are also discussed in Chapter 4. In 2007, the first national agenda-setting document was issued (National Programme for Spatial Planning Policy/PNPOT) and recently renewed, in 2019, for ten more years. The diagnosis of spatial and urban planning clearly identifies governance, lack of cooperation mechanisms and networks, and “territorial deficit” as the most pervasive obstacle. Yet, it establishes many goals which directly depend on these to be successfully implemented. I have also addressed the existing national spatial and urban planning rule of law which, according to experts, is satisfying. However, it is acknowledged that there is a significant gap between legislation and implementation due to several contextual obstacles. I argue that both the EU and Portugal need to harmonise and consistently articulate their institutional, policy and legal framework. Only then there will be an alignment between a vision and the operation level. Corruption, democracy, accountability, partnerships, transparency: These are common dimensions of governance that I have addressed in the context of transforming the 2030 Agenda goals into national goals, using either binding or nonbinding strategies. Due to the agenda’s policy integration approach, governance systems need to be more flexible and open to adapt to current challenges and an increasingly VUCA world. Organisational adequacy and system design need to be updated and renewed, and I identify some of the main obstacles in the Portuguese context. This renovation can only take place by implementing mechanisms that empower leadership, decentralised decision-making capacity and cooperation. As much as Portugal needs to strengthen its mid-level governance,

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the regional level, as long as these matters are not effectively addressed, it is not advisable to go forward with regionalisation as it will only expand current problems in these areas leading to waste of financial and human resources and eroding citizens’ trust. Democratising institutions and public policy; human capital: Change can only happen through people. Partnerships, citizen participation and consensus, are essential. System-wise, it is vital to promote traineeships to ensure the necessary technical and financial resources needed; to evaluate and monitor plans and programmes assuming high-quality standards; and correctly improve, design and implement them. Context-wise, there is a massive shift in Portugal previously mentioned that must be taken advantage of to the fullest: up until 2007, most full-time employees had four years of schooling (22,7%). For the first time, in 2020, most employees have a university degree (31,5%). In 13 years, available human resources have dramatically increased in quality. Portugal seems to be ready to break the inequality/education cycle and finally bring democracy to its institutions. This can bring added value and local empowerment at the institutional/system level. Efficiency, effectiveness and feasibility: Efficiency is a short-term strategy closely related to the operational level. It relates to processes put in motion to present specific previously established results. Effectiveness is a long-term strategy closely related to the strategic level and a vision. It relates with the system and is assessed through outputs agreed upon by several parties, allowing us to evaluate if results are long-lasting and in which way they extend beyond a given set of processes. A sound governance system has efficiency and effectiveness when in complete alignment. The 2030 Agenda’s goals, targets and indicators reflect this intention. This is why it is a great opportunity for each country that has agreed upon the goals to formulate its own set of indicators to make sure that the national system is committed to set in motion necessary processes to deliver results—which, if improved over time, become long-lasting, having the ability to change the system for the better. In synch with the policy integration of the agenda, indicators will perform more robustly (i.e. allowing for better monitoring and evaluation) if assessed along with other indicators. This was my strategy to suggest a given set of indicators. What is important to clarify in terms of feasibility is if data is available to monitor a given indicator and who is responsible for providing data regularly.

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Future prospects: In an ideal world, public policy would follow research recommendations, but that is not always the case for many different reasons. Agenda-setting documents and other nonbinding instruments can therefore be helpful to facilitate the transition. This book aims to provide a concise overview of up-to-date research and documentation, delivering a critical analysis and options that may inspire the design and implementation of multilevel and intersectoral joint policies that simultaneously benefit health and spatial and urban planning. International, transnational and even national overarching documents, particularly in the realm of spatial and urban planning, point in that direction. A growing body of research supports it, and hopefully, it is a research area that will develop contributing with a wide range of creative and effective solutions. The urgent question is: which obstacles are preventing joint public policies to be operationalised at the national level? This is why governance is crucial to address in the health and spatial and urban planning realms and in a broader context. To find out how to change the current national governance system so that the political democracy matches its institutions, policy and processes, is a work in progress. Still, hopefully, the 2030 Agenda provides a much-needed boost.

References

Anonymous. (1996). Towards a supranational spatial development perspective: Experience in Europe. Journal of Planning Education and Research, 15(2), 135–142. https://doi.org/10.1177/0739456X9601500206 Anonymous (2021, May 6). Regime para reverter freguesias agregadas em 2013 só deverá entrar em vigor após autárquicas. Jornal Observador. https://observador.pt/2021/05/06/regime-para-reverter-freguesiasagregadas-em-2013-so-devera-entrar-em-vigor-apos-autarquicas/ 2030 Agenda. (2015). A/RES/70/1 - Transforming our world: the 2030 Agenda for Sustainable Development. United Nations. https://sdgs.un.org/2030ag enda Abbott, A. (2012). Stress and the city: Urban decay. Nature, 490, 162–164 (11 October). https://doi.org/10.1038/490162a ADC. Agência para o Desenvolvimento & Coesão IP. (2021). Fundos da União Europeia—1986–1988, QCA I, II, III e QREN . https://www.adcoesao.pt/ content/1986-1988-qca-i-ii-iii-e-qren Adler-Nissen, R. (2014). Opting out of the European Union: Diplomacy, sovereignty and european integration. Cambridge University Press. Agenda 21. (1992). Sustainable development goals—Knowledge platform. United Nations. https://sustainabledevelopment.un.org/milestones/unced Ahrend, R., Lembcke, A. C., & Schumann, A. (2017). The role of urban agglomerations for economic and productivity growth. International productivity monitor, 32, 161–179. https://EconPapers.repec.org/RePEc:sls:ipmsls:v:32: y:2017:9

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 D. Soeiro, Cities, Health and Wellbeing, Sustainable Urban Futures, https://doi.org/10.1007/978-3-030-89348-4

161

162

REFERENCES

Albrechts, L. (1997). Genesis of a Western European spatial policy? Journal of Planning Education and Research, 17 , 158–167. https://doi.org/10.1177/ 0739456X9701700206 Albrechts, L. (2006). Bridge the gap: From spatial planning to strategic projects. European Planning Studies, 14(10), 1487–1500. https://doi.org/10.1080/ 09654310600852464 Ali, T. M. (2012). The impact of the sovereign debt crisis on the Eurozone countries. Procedia—Social and Behavioral Sciences, 62, 424–430. https:// doi.org/10.1016/j.sbspro.2012.09.069 Alves, R. P. (2017). Portugal: A paradox in productivity. International Productivity Monitor, 32, 137–160. https://EconPapers.repec.org/RePEc:sls:ipmsls: v:32:y:2017:8 Alves Correia, F. (1990). O plano urbanístico e o princípio da igualdade. Almedina. Alves Correia, F. (2014). A nova lei de bases gerais da política de solos, de ordenamento do território e de urbanismo: Alguns princípios fundamentais. RevCedoua, 34, 9–21. Alves Correia, F. (2018). Evolução do Direito do Urbanismo em Portugal de 2012 a 2017. Cedoua, 41, 9–25. Amaral, D. F. do (1989). Direito do urbanismo. Instituto Nacional de Administração. Amaral, D. F. do (1991). Apreciação da dissertação de doutoramento do licenciado Fernando Alves Correia: O plano urbanístico e o princípio da igualdade. Sep. de Revista da Faculdade de Direito. 91–105. Arquivo Histórico (2021). Governos Constitucionais. Governo da República Portuguesa. https://www.historico.portugal.gov.pt/ Amaro Alves, R. M. (2007). Políticas de Planeamento e Ordenamento do Território no Estado Português. Fundação Calouste Gulbenkian. Berry, H. L., Bowen, K., & Kjellstrom, T. (2010). Climate change and mental health: A causal pathways framework. International Journal of Public Health, 55, 123–132. https://doi.org/10.1007/s00038-009-0112-0 Banque de France. (2012). Public debt, monetary policy and financial stability. Financial Stability Review, 16(April). https://abc-economie.banque-france. fr/sites/default/files/medias/documents/financial-stability-review-16_201204.pdf#page=109 Barreto, F. (2011). Contributo para a história da arquitectra paisagista em Portugal: Arquitecto paisagista António Facco Vianna Barreto [Master’s dissertation, Universidade Técnica de Lisboa]. UTL Repository. https://www.rep ository.utl.pt Barton, J., & Rogerson, M. (2017). The importance of greenspace for mental health. Bjpsych. International, 14(4), 79–81. https://doi.org/10.1192/S20 56474000002051

REFERENCES

163

Bento, A., Carrera, M., & Heitor, M. J. (2001). Censo Psiquiátrico de 2001. Síntese dos resultados. Ministério da Saúde, Direcção-Geral da Saúde. https://www.dgs.pt/documentos-e-publicacoes/censo-psiquiatr ico-de-2001-.aspx Berardi, C., Antonini, M., Genie, M. G., Cotugno, G., Lanteri, A., Melia, A., & Paolucci, F. (2020). The COVID-19 pandemic in Italy: Policy and technology impact on health and non-health outcomes. Health Policy and Technology, 9(4), 454–487. https://doi.org/10.1016/j.hlpt.2020.08.019 Bernard, J., Rodler, A., Morille, B., & Zhang, X. (2018). How to design a park and its surrounding urban morphology to optimize the spreading of cool air? Climate, 6(1). https://doi.org/10.3390/cli6010010 Birch, J., Rishbeth, C., & Payne, S. R. (2020). Nature doesn’t judge you— How urban nature supports young people’s mental health and well-being in a diverse UK city. Health & Place, 62, 102296. https://doi.org/10.1016/j. healthplace.2020.102296 Bornemann, B., & Weiland, S. (2021). The UN 2030 agenda and the quest for policy integration: A literature review. Politics and Governance, 9(1). https:// doi.org/10.17645/pag.v9i1.3654 Brigance, C., Soto Mas, F., Sanchez, V., & Handal, A. J. (2018). The mental health of the organic farmer: Psychosocial and contextual actors. Workplace Health & Safety, 66(12), 606–616. https://doi.org/10.1177/216507991 8783211 Bourque, F., & Willox, A. (2014). Climate change: The next challenge for public mental health? International Review of Psychiatry, 26, 415–422. https://doi. org/10.3109/09540261.2014.925851 Caldas de Almeida, J. M., Mateus, P., Xavier, M., & Tomé, G. (2015). Joint acton on mental health and well-being. Towards community-based and socially inclusive mental health care. Análise da situação em Portugal. Sociedade Portuguesa de Geriatria e Gerontologia Website. http://spgg.com. pt/UserFiles/file/23_09_15report_JA_em_PORTUGUES.pdf Callan, T., Leventi, C., Levy, H., Matsaganis, M. Paulus, A., & Sutherland, H. (2011). The distributional effects of austerity measures: A comparison of six EU countries. EUROMOD Working Paper, No. EM6/11. Institute for Social and Economic Research (ISER), University of Essex. http://hdl.handle.net/ 10419/64872 Carvalho, J. (2016). Matriz estruturante de territórios urbanos emergentes. In J. Carvalho & F. P. Oliveira (Eds.), Classificação do solo no novo quadro legal (pp. 59–90). Almedina. Carvalho, J., & Oliveira, F. P. (2016). Classificação, reclassificação e qualificação do solo no novo quadro legal. In J. Carvalho & F. P. Oliveira (Eds.), Classificação do solo no novo quadro legal (pp. 9–36). Almedina.

164

REFERENCES

CCDR-LVT. (2021). Breve historial CCDR. Comissão de Coordenação e Desenvolvimento Regional de Lisboa e Vale do Tejo Webite. http://www.ccdr-lvt.pt/ pt/breve-historial-ccdr/9595.htm CD. Commission Decision 1786/2002/EC. (2002). Decision No 1786/2002/EC of the European Parliament and of the Council of 23 September 2002 adopting a programme of Community action in the field of public health (2003–2008). Official Journal of the European Communities, L 271/1, 9.10.2002. CELEX number: 32002D1786. https://eur-lex.eur opa.eu/ CD. Commission Decision 2004/858/EC. (2004). Commission Decision of 15 December 2004 setting up an executive agency, the ‘Executive Agency for the Public Health Programme’, for the management of Community action in the field of public health — pursuant to Council Regulation (EC) No 58/2003. Official Journal of the European Communities, L 369/73, 16.12.2004. CELEX number: 32004D0858. https://eur-lex.europa.eu/ CD. Commission Decision 1350/2007/EC. (2007). Decision No 1350/2007/EC of the European Parliament and of the Council of 23 October 2007 establishing a second programme of Community action in the field of health (2008–13). Official Journal of the European Communities, L 301/3, 20.11.2007. CELEX number: 32007D1350. https://eur-lex.eur opa.eu/ CD. Commission Decision. (2018). 4492 final (2018). Commission Decision of 17.7.2018 setting up a Commission expert group “Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases” and (…). European Commission. https://ec.europa.eu/health/ sites/default/files/major_chronic_diseases/docs/c2018_4492_en.pdf Centers for Disease Control and Prevention. (2021). SARS-CoV-2 variant classifications and definitions. https://www.cdc.gov/coronavirus/2019-ncov/var iants/variant-info.html Chatterjee, K., Chng, S., Clark, B., Davis, A., De Vos, J., Ettema, D., Handy, S., Martin, A., & Reardon, L. (2020). Commuting and well-being: A critical overview of the literature with implications for policy and future research. Transport Reviews, 40(1), 5–34. https://doi.org/10.1080/01441647.2019. 1649317 Cianconi, P., Betrò, S., & Janiri, L. (2020). The impact of climate change on mental health: A systematic descriptive review. Front. Psychiatry. https://doi. org/10.3389/fpsyt.2020.00074 Clemens, T., Sørensen, K., Rosenkötter, N., Michelsen, K., & Brand, H. (2017). The directorate-general for health and consumers 1999–2014: An assessment of its functional capacities. Health Policy, 121(6), 594–603. https://doi.org/ 10.1016/j.healthpol.2017.03.018

REFERENCES

165

CNRSSM. Comissão Nacional para a Reestruturação dos Serviços de Saúde Mental. (2007). Relatório da Comissão Nacional para a Reestruturação dos Serviços de Saúde Mental (April). www.hmlemos.min-saude.pt/docs/PNacSM 2007.pdf Consilium. (2021). Infographic—Multiannual financial framework 2021–2027 and Next-Generation EU. European Council, Council of the European Union Website. https://www.consilium.europa.eu/en/infographics/mff2021-2027ngeu-final/ Corkill, D. (1999). Portugal’s 1998 referendums. West European Politics, 22(2), 186–192. https://doi.org/10.1080/01402389908425308 Costa, L., Guedes de Oliveira, F., Leitão, A., & Paredes, J. (2021). Business cycles and trends in Germany and Portugal: Macroeconomic policy implications in the Euro Area. European Planning Studies, 29(4), 654–680. https:// doi.org/10.1080/09654313.2020.1766424 Côté-Roy, L., & Moser, S. (2018). ‘Does Africa not deserve shiny new cities?’ The power of seductive rhetoric around new cities in Africa. Urban Studies, 56(12), 2391–2407. https://doi.org/10.1177/0042098018793032 Council of Europe. (2021). Conference of Ministers responsible for Spatial/Regional Planning (CEMAT). Council of Europe Website. https:// www.coe.int/en/web/conference-ministers-spatial-planning/ministerial-con ferences Cranz, G., & Boland, M. (2004). Defining the sustainable park: A fifth model for urban parks. Landscape Journal, 23(2), 102–120. http://www.jstor.org/ stable/43323666 CTARSM. Comissão Técnica de Acompanhamento da Reforma da Saúde Mental. (2017). Relatório da Avaliação do Plano Nacional de Saúde Mental 2007– 2016 e propostas prioritárias para a extensão a 2020 (Julho). Serviço Nacional de Saúde Website. https://www.sns.gov.pt/wp-content/uploads/2017/08/ RelAvPNSM2017.pdf Cunha, M. L. (2021, April 21). Limitação de mandatos obriga 38 autarcas a deixar presidências de câmara. Observador. https://observador.pt/2021/ 04/21/limitacao-de-mandatos-obriga-38-autarcas-a-deixar-presidencias-decamara/ Dallhammer, E., Gaugitsch, R., Neugebauer, W., & Böhme, K. (2018). Spatial planning and governance within EU policies and legislation and their relevance to the New Urban Agenda. European Committee of the Regions—COTER. https://doi.org/10.2863/0251 DG SANCO. (2011). Ex-post evaluation of the Public Health Programme (PHP) 2003–2008. Final report (March). https://ec.europa.eu/health/sites/ health/files/programme/docs/ex_post_evaluation_en.pdf

166

REFERENCES

DG SANTE. (2015). Ex-post evaluation of the health programme (2008–2013). Final report (Ref. Ares (2015)3227899 - 31/07/2015). https://doi.org/10. 2875/476930 Sante, D. G. (2017). Mid-term evaluation of the third health programme (2014– 2020). Publications Office of the European Union. https://doi.org/10. 2875/359384 DGO. Direcção-Geral do Orçamento. (2019). Ministério – Despesa de 2018. http://online.dgo.pt/DadosCidadao/Orcamento_CG.Entrada.aspx DGT. (2015). Cidades Sustentáveis 2020. Direcção-Geral do Território e Ministério do Ambiente, Ordenamento do território e Energia. https:// www.dgterritorio.gov.pt/sites/default/files/ficheiros-cidades/Cidades_Sust entaveis2020.pdf DGT. (2021). Cronologia Histórica da Direcção-Geral do Território. DirecçãoGeral do Território Website. https://www.dgterritorio.gov.pt/dgt/historia-pat rimonio/cronologia-historica?language=en Dobson, J., Birch, J., Brindley, P., Henneberry, J., McEwan, K., Mears, M., Richardson, M., & Jorgensen, A. (2021). The magic of the mundane: The vulnerable web of connections between urban nature and well-being. Cities, 108,102989. https://doi.org/10.1016/j.cities.2020.102989 Donald, B., Glasmeier, A., Gray, M., & Lobao, L. (2014). Austerity in the city: Economic crisis and urban service decline? Cambridge Journal of Regions, Economy and Society, 7 (1), 3–15. https://doi.org/10.1093/cjres/rst040 Dühr, S., Stead, D., & Zonneveld, W. (2007). The Europeanization of spatial planning through territorial cooperation. Planning Practice & Research, 22(3), 291–307. https://doi.org/10.1080/02697450701688245 EC. European Commission. (2000). The EU compendium of spatial planning systems and policies—Portugal. Regional Development Studies, Luxembourg: Office for Official Publications of the European Communities. CX-10-97817-EN-C. https://op.europa.eu/en/ EC. European Commission. (2003). Partnership with the cities: The URBAN community initiative. Directorate General—Regional Policy. https://ec.eur opa.eu/regional_policy/sources/docgener/presenta/cities/cities_en.pdf EC. European Commission. (2017). Mid-term evaluation of the 3rd Health programme 2014–2020 under Regulation (EU) No 282/2014 on establishing a third programme of Union action in the field of health (2014–2020). SWD (2017) 333 final, 11.10.2017. https://ec.europa.eu/health/sites/hea lth/files/programme/docs/2014-2020_evaluation_cswdexe_en.pdf EC. European Commission. (2019a). European Commission – Business, economy, euro. https://ec.europa.eu/info/business-economy-euro/economic-and-fis cal-policy-coordination/eu-economic-governance-monitoring-prevention-cor rection_en

REFERENCES

167

EC. European Commission. (2019b). Business, Economy, EuroEconomic and fiscal policy coordination. EU Economic governance: Monitoring, prevention, correction. Macroeconomic imbalance procedure. In-depth reviews [Country Reports]. https://ec.europa.eu/info/business-economy-euro/economicand-fiscal-policy-coordination/eu-economic-governance-monitoring-preven tion-correction/macroeconomic-imbalance-procedure/depth-reviews_en EC. European Commission. (2011). Green infrastructure and territorial cohesion. https://www.eea.europa.eu/themes/publications/green-infrastructureand-territorial-cohesion EC. European Commission. (2013). Green infrastructure (GI)—Enhancing Europe’s natural capital—COM (2013). CELEX number: 52013DC0249. https://eur-lex.europa.eu/ EC. European Commission. (2021a). History of the [regional] policy. https://ec. europa.eu/regional_policy/en/policy/what/history/ EC. European Commission. (2021b). A long-term vision for the EU’s rural areas. https://ec.europa.eu/info/strategy/priorities-2019-2024/new-pusheuropean-democracy/long-term-vision-rural-areas_en#documents EC Country Report. (2016). Country Report Portugal 2016. Including an In-Depth Review on the prevention and correction of macroeconomic imbalances. 26.2.2016 SWD (2016) 90 final. https://ec.europa.eu/info/bus iness-economy-euro/economic-and-fiscal-policy-coordination/eu-economicgovernance-monitoring-prevention-correction/macroeconomic-imbalancesprocedure/depth-reviews_en EC Country Report. (2017). Country Report Portugal 2017. Including an In-Depth Review on the prevention and correction of macroeconomic imbalances. 22.2.2017 SWD (2017) 87 final. https://ec.europa.eu/info/bus iness-economy-euro/economic-and-fiscal-policy-coordination/eu-economicgovernance-monitoring-prevention-correction/macroeconomic-imbalancesprocedure/depth-reviews_en EC Country Report. (2018). Country Report Portugal 2018. Including an In-Depth Review on the prevention and correction of macroeconomic imbalances. 7.3.2018 SWD (2018) 220 final. https://ec.europa.eu/info/bus iness-economy-euro/economic-and-fiscal-policy-coordination/eu-economicgovernance-monitoring-prevention-correction/macroeconomic-imbalancesprocedure/depth-reviews_en EC Country Report. (2019). 2019 European Semester: Country Specific Recommendation / Commission Recommendation - Portugal. 5.6.2019 COM (2019) 522 final. https://ec.europa.eu/info/business-economy-euro/ economic-and-fiscal-policy-coordination/eu-economic-governance-monito ring-prevention-correction/macroeconomic-imbalances-procedure/depth-rev iews_en

168

REFERENCES

EC-DGEFA/ European Commission - Directorate-General for Economic and Financial Affairs. (2015). European Economy. Macroeconomic imbalances Country Report – Portugal 2015. Occasional Papers 222: Directorate-General for Economic and Financial Affairs. https://ec.europa.eu/economy_finance/ publications/occasional_paper/2015/pdf/ocp222_en.pdf EC-DG Sante. (2019). What we do - Directorate-General - Sante. European Commission. https://ec.europa.eu/info/departments/health-and-foodsafety/what-we-do-health-and-food-safety_en EC-EG. European Commission-European Governance. (2001). A White Paper. Brussels, 25.7.2001. COM (2001) 42. https://ec.europa.eu/commission/ presscorner/detail/en/DOC_01_10 EC-EGD. European Commission-European Green Deal. (2021). Strategy, priorities 2019–2024, A European Green Deal. https://ec.europa.eu/info/str ategy/priorities-2019-2024/european-green-deal_en EC Public Health. (2019a). Public Health. Live, work, travel in the EU. European Commission. https://ec.europa.eu/health/home_en EC Public Health. (2019b). Non-communicable diseases. Public Health. Live, work, travel in the EU. European Commission. https://ec.europa.eu/health/ non_communicable_diseases/overview_en EC Public Health. (2019c). EU Health Programme. Public Health. Live, work, travel in the EU. European Commission. https://ec.europa.eu/health/fun ding/programme_en EC SGPP. (2019). Steering Group on Promotion and Prevention, or SGPP. Non-communicable diseases. Public Health. Live, work, travel in the EU. European Commission. https://ec.europa.eu/health/non_communicable_dis eases/steeringgroup_promotionprevention_en ES. European Semester. (2019). The framework - The EU’s economic governance explained. https://ec.europa.eu/info/business-economy-euro/eco nomic-and-fiscal-policy-coordination/eu-economic-governance-monitoringprevention-correction/european-semester/framework/eus-economic-govern ance-explained_en ECORYS. European Commission: DG Regional and Urban Policy. (2014). Sustainable urban development in Portugal: An integrated approach. Publications Office of the European Union. https://www.europeansources.info Elden, S. (2013). How should we do the history of territory? Territory, Politics, Governance, 1(1), 5–20. https://doi.org/10.1080/21622671.2012.733317 Elsadek, M., Liu, B. & Lian, Z. (2019). Green façades: Their contribution to stress recovery and well-being in high-density cities. Urban Forestry & Urban Greening, 46, 126446. https://doi.org/10.1016/j.ufug.2019.126446 EOHSP. (2019). State of Health in the EU, Portugal – Country Health profile 2019. European Observatory on Health Systems and Policies. https://eur

REFERENCES

169

ohealthobservatory.who.int/publications/m/portugal-country-health-profile2019 EP. European Parliament. (2019). Requested by the REGI committee. Economic, social and territorial situation of Portugal [Briefing]. https://www.europarl. europa.eu/RegData/etudes/BRIE/2019/629190/IPOL_BRI(2019)629 190_EN.pdf Epstein, D. (2019). Range: Why generalists triumph in a specialized world. Riverhead Books. Etxano, I., & Villalba-Eguiluz, U. (2021). Twenty-five years of social multicriteria evaluation (SMCE) in the search for sustainability: Analysis of case studies. Ecological Economics, 188, 107131. https://doi.org/10.1016/j.eco lecon.2021.107131 EU Joint Action on Mental Health and Wellbeing. (2016). European framework for action on mental health and wellbeing. Final Conference—Brussels (21–22 January). https://ec.europa.eu/research/participants/data/ref/h2020/ other/guides_for_applicants/h2020-SC1-BHC-22-2019-framework-for-act ion_en.pdf Eurostat. (2021). NUTS. https://ec.europa.eu/eurostat/web/nuts/ EUROSTAT-EC. European Commission. (2021). EU SDG Indicator set 2021: Result of the review in preparation of the 2021 edition of the EU SDG monitoring report. Directorate E: Sectoral and Regional Statistics Unit E-2: Environmental statistics and accounts; sustainable development. Final version of 15/01/2021. https://ec.europa.eu/eurostat/documents/ 276524/12239692/SDG_indicator_set_2021.pdf Fadigas, L. (2015). Urbanismo e Território. Edições Sílabo. Faris, R. E. L., & Dunham, H. W. (1939). Mental disorders in urban areas: An ecological study of schizophrenia and other psychoses. University of Chicago Press. Faludi, A. (2021). European history and traditions: Revisiting the European spatial development perspective. In M. Neuman & W. Zonneveld (Eds.), The Routledge handbook of regional design (pp. 33–47). Taylor & Francis. https:// doi.org/10.4324/9780429290268-4 Farole, T., Rodríguez-Pose, A., & Storper, M. (2011). Cohesion policy in the European Union: Growth, geography, institutions. Journal of Common Market Studies, 49(5), 1089–1111. https://doi.org/10.1111/j.1468-5965. 2010.02161.x Ferrão, J. (2002). Portugal, três geografias em recombinação: Espacialidades, mapas cognitivos e identidades territorais. Lusotopie, 9(9), 151–158. Ferrão, J. (2010). Ordenamento do território: 25 anos de aprendizagem. Europa—Novas Fronteiras, 26/27 , 77–84. Ferrão, J. (2019). O Programa Nacional da Política de Ordenamento do Território: Da ideia à prática. Public Policy Portuguese Journal, 4(2), 7–11.

170

REFERENCES

Ferreira, A. (2019). A Implementação da Reorganização Administrativa do Território das Freguesias em Portugal nas Perspetiva dos Cidadãos [Master’s dissertation, Universidade de Coimbra]. UC Repository. http://hdl.handle. net/10316/85944 Frias, P., & Pinto da Costa, M. (2020). Community psychiatry in Portugal: A critical review. Consortium Psychiatricum, 1(1), 49–59. https://doi.org/10. 17650/2712-7672-2020-1-1-49-59 Fominaya, C. F. (2017). European anti-austerity and pro-democracy protests in the wake of the global financial crisis. Social Movement Studies, 16(1), 1–20. https://doi.org/10.1080/14742837.2016.1256193 Friedrich, J. (2013). International environmental “soft law”: The functions and limits of nonbinding instruments in international environmental governance and law. Springer. Futurium. (2021). Urban agenda for the EU. What is the urban agenda for the EU? https://futurium.ec.europa.eu/en/urban-agenda/pages/whaturban-agenda-eu Gamper, C. D., & Turcanu, C. D. (2007). On the governmental use of multicriteria analysis. Ecological Economics, 62(2), 298–307. https://doi.org/10. 1016/j.ecolecon.2007.01.010 Geiger, N. (2015). The rise of behavioural economics: A quantitative assessment. [Research Paper] No. 44/2015, Universität Hohenheim, Stuttgart. http:// nbn-resolving.de/urn:nbn:de:bsz:100-opus-10845 Giang, D. T. H., & Pheng, L. S. (2011). Role of construction in economic development: Review of key concepts in the past 40 years. Habitat International, 35(1), 118–125. https://doi.org/10.1016/j.habitatint.2010.06.003 Giles-Corti, B., Vernez-Moudon, A., Reis, R., Turrell, G., Dannenberg, A. L., Badland, H., Foster, S., Lowe, M., Sallis, J. F., Stevenson, M., & Owen, N. (2016). City planning and population health: A global challenge. The Lancet, 6736(16), 30066. https://doi.org/10.1016/S0140-6736(16)30066-6 Green Paper on Territorial Cohesion. (2009). CELEX number: 52009IP0163. https://eur-lex.europa.eu/ Guizhen, H., Mol, A. P. J., & Lu, Y. (2016). Wasted cities in urbanizing China. Environmental Development, 18, 2–13. https://doi.org/10.1016/j.envdev. 2015.12.003 He, G., Mol, A. P. J., & Lu, Y. (2016). Wasted cities in urbanizing China. Environmental Development, 18, 2–13. https://doi.org/10.1016/j.envdev.2015. 12.003 Hadjimichalis, C. (2011). Uneven geographical development and socio-spatial justice and solidarity: European regions after the 2009 financial crisis. European Urban and Regional Studies, 18(3), 254–274. https://doi.org/10. 1177/0969776411404873

REFERENCES

171

Hahn, J. (Ed.) (2012). Cohesion Policy 2014–2020—Investing in Europe’s regions. Panorama—Inforegio, 40(Winter 2011/2012). https://ec.europa. eu/regional_policy/sources/docgener/panorama/pdf/mag40/mag40_en. pdf Hanakata, N. C., & Gasco, A. (2018). The Grand Projet politics of an urban age: Urban megaprojects in Asia and Europe. Palgrave Commun, 4, 86. https:// doi.org/10.1057/s41599-018-0141-5 Harris, B., & Helgertz, J. (2019). Urban sanitation and the decline of mortality. The History of the Family, 24(2), 207–226. https://doi.org/10.1080/108 1602X.2019.1605923 Healey, P. (2004). The treatment of space and place in the new strategic spatial planning in Europe. International Journal of Urban and Regional Research, 28(1), 45–67. https://doi.org/10.1111/j.0309-1317.2004.00502.x Health System Review – Portugal. (2018). Final Report (April), World Health Organization. Serviço Nacional de Saúde Website. https://www.sns.gov. pt/wp-content/uploads/2018/04/PortugalReviewReport_Printers_03Apri l2018-2.pdf Heitor dos Santos, M. J., Gusmão, R., Ferreira, S., & Santos, M. (2006). “Portugal”. In E. Jané-Llopis & P. Anderson, (Eds.), Mental health promotion and mental disorder prevention across European Member States: a collection of country stories (pp. 129–134). European Communities. http://europa.eu. int/comm/health/ph_determinants/healthdeterminants_en.htm IAEG-SDGs. (2016). Final list of proposed Sustainable Development Goal indicators. Report of the Inter-Agency and Expert Group on Sustainable Development Goal Indicators (E/CN.3/2016/2/Rev.1), Annex IV. https://sustainabledevelopment.un.org/content/documents/11803Offi cial-List-of-Proposed-SDG-Indicators.pdf INE. Instituto Nacional de Estatística. (2021). Objetivos de Desenvolvimento Sustentável—Agenda 2030. Indicadores para Portugal: 2010–2020. https:// www.ine.pt/xurl/pub/280981585 Interreg. (2021). About us. Interreg website. https://www.interregeurope.eu/ about-us/what-is-interreg-europe/ Jackson, T. (2011). Prosperity without growth. Earthscan. Jaffe, E. (2015, October 20). The (Pretty much totally) complete health case for urban nature: An annotated, chart-filled look at scientific evidence. The Atlantic Citylab. https://www.citylab.com/environment/2015/10/the-pre tty-much-totally-complete-health-case-for-urban-nature/411331/ JE. Jornal Económico. (2021, June 22). Mais de metade das autarquias viola lei de proteção de dados. Jornal Económico. https://jornaleconomico.sapo. pt/noticias/mais-de-metade-das-autarquias-viola-lei-de-protecao-de-dados753529

172

REFERENCES

Jennings, V., & Bamkole, O. (2019). The relationship between social cohesion and urban green space: An avenue for health promotion. International Journal of Environmental Research and Public Health, 16(3), 452. https:// doi.org/10.3390/ijerph16030452 Kah, S., Georgieva, N., & Fonseca, L. (2020). EU cohesion policy in non-urban areas. European Parliament Website. Policy Department for Structural and Cohesion Policies, Brussels. https://www.europarl.europa.eu/RegData/etu des/STUD/2020/652210/IPOL_STU(2020)652210_EN.pdf Kanie, N., Bernstein, S., Biermann, F., & Haas, P. M. (2017). Introduction: Global governance through goal setting. In N. Kanie & F. Biermann (Eds.), Governing through goals: Sustainable development goals as governance innovation (pp. 1–27). MIT Press. Karimi, M., & Brazier, J. (2016). Health, health-related quality of life, and quality of life: What is the difference? PharmacoEconomics, 34(7), 645–649. https://doi.org/10.1007/s40273-016-0389-9 PMID: 26892973. Keating, M. (2008). Thirty years of territorial politics. West European Politics, 31(1–2), 60–81. https://doi.org/10.1080/01402380701833723 Kubbe, I. (2018). Europe’s “democratic culture” in the fight against corruption. Crime Law Soc Change, 70, 217–240. https://doi.org/10.1007/s10 611-017-9728-9 Lak, M. (2020). Europe and the European Union in times of growing scepticism. Journal of World History, 31(1), 236–250. https://doi.org/10.1353/ jwh.2020.0010 Lederbogen, F., Kirsch, P., Haddad, L., Streit, F., Tost, H., Schuch, P., Wüst, S., et al. (2011). City living and urban upbringing affect neural social stress processing in humans. Nature, 474, 498–501. https://doi.org/10.1038/nat ure10190 Lewis, G., David, A., Andréassson, S., & Allebeck, P. (1992). Schizophrenia and city life. The Lancet, 340(8812), 137–140. https://doi.org/10.1016/01406736(92)93213-7 Lewis, T. M. (2009). Quantifying the GDP-construction relationship. In L. Ruddock (Ed.), Economics for the modern built environment (pp. 34–59). Taylor & Francis. Li, Q., Guan, X., Wu, P., Wang, X., Zhou, L., Tong, Y., & Feng, Z. (2020). Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. New England Journal of Medicine, 382, 1199–1207. https://doi. org/10.1056/NEJMoa2001316 Maastricht Treaty. (1993). European Parliament. 7 February 1992. https:// www.europarl.europa.eu/about-parliament/en/in-the-past/the-parliamentand-the-treaties/maastricht-treaty Marcantonio, R., Javeline, D., Field, S., & Fuentes, A. (2021). Global distribution and coincidence of pollution, climate impacts, and health risk in the

REFERENCES

173

Anthropocene. PLoS ONE, 16(7). https://doi.org/10.1371/journal.pone. 0254060 Marcelis, M., Navarro-Mateu, F., Murray, R., Selten, J. P., & Van Os, J. (1998). Urbanization and psychosis: A study of 1942–1978 birth cohorts in The Netherlands. Psychological Medicine, 28(4), 871–879. https://doi.org/10. 1017/s0033291798006898 Meadows, D. H., Randers, J., & Meadows, D. L. (2004). Limits to growth: The 30-year update. Chelsea Green Publishing. Medeiros, E., & Rauhut, D. (2020). Territorial cohesion cities: A policy recipe for achieving territorial cohesion? Regional Studies, 54(1), 120–128. https:// doi.org/10.1080/00343404.2018.1548764 Mendes, L. (2012). De que se fala quando se fala de RAN e REN? [Master’s dissertation, Universidadte do Porto]. UP Repository. https://repositorio-abe rto.up.pt/ Mendes, S. M., & Camões, P. J. (2005). Corruption and political institutions in Portugal: An exploratory analysis. Annual Meeting of the European Consortium for Political Research, 3, Budapeste. http://hdl.handle.net/ 1822/3802 Mercer. (2019). Mobility, insights, quality of living ranking. https://mobilitye xchange.mercer.com/insights/quality-of-living-rankings Midgley, J. (2014). Austerity versus stimulus: Theoretical perspectives and policy implications. The Journal of Sociology & Social Welfare, 41(2), 3. https://sch olarworks.wmich.edu/jssw/vol41/iss2/3 Ministério da Saúde. (2002). Ganhos de Saúde em Portugal – Ponto de situação. Relatório do Director-Geral e Alto-Comissário da Saúde. Março. Ministério da Saúde, Direcção Geral da Saúde. https://www.dgs.pt/documentos-epublicacoes/ganhos-de-saude-em-portugal-ponto-da-situacao-relatorio-do-dir ector-geral-e-alto-comissario-da-saude.aspx Ministério da Saúde. (2003). Plano Nacional de Saúde. Prioridades para 2004– 2010 (Dezembro). https://www.dgs.pt/documentos-e-publicacoes/planonacional-de-saude.aspx Ministério da Saúde. (2004a). Plano Nacional de Saúde. Prioridades para 2004– 2010 (11 Fevereiro). https://www.dgs.pt/documentos-e-publicacoes/planonacional-de-saude1.aspx Ministério da Saúde. (2004b). Plano Nacional de Saúde. Orientações Estratégicas para 2004–2010 (11 Fevereiro). https://www.dgs.pt/documentos-e-pub licacoes/plano-nacional-de-saude2.aspx Ministério da Saúde. (2004c). Plano Nacional de Saúde. Prioridades para 2004–2010 (Julho). https://www.dgs.pt/documentos-e-publicacoes/planonacional-de-saude-2004-20101.aspx

174

REFERENCES

Ministério da Saúde. (2004d). Plano Nacional de Saúde. Orientações Estratégicas para 2004–2010 (Julho). https://www.dgs.pt/documentos-e-publicacoes/ plano-nacional-de-saude-2004-2010.aspx Ministério da Saúde. (2004e). Plano de Acção para a Saúde 2004 – Áreas prioritárias (Março). https://www.dgs.pt/documentos-e-publicacoes/planode-accao-para-a-saude-2004-areas-prioritarias.aspx Ministry of Health. (2003). Contributions to the National Health Plan – Strategic Guidelines 2003 (31.01.2003). https://www.dgs.pt/documentos-epublicacoes/national-health-plan-english-version.aspx Ministry of Health. (2004). National Health Plan 2004–2010. Volume I – Priorities (July). https://www.dgs.pt/ficheiros-de-upload-1/pns-versao-ingles-dez 2004-pdf.aspx MNE. Ministério dos Negócios Estrangeiros. (2017, June 28), A Agenda 2030 em Portugal – Informação à Imprensa. https://issuu.com/comissaonaciona ldaunesco/docs/agenda_2030_em_portugal Mongelli, F. P., Reinhold, E., & Papadopoulos, G. (2015). What’s so special about specialization in the euro area? Early evidence of changing economic structures. European Central Bank. https://doi.org/10.2866/34495 Monkelbaan, J. (2019). Governance for the sustainable development goals exploring an integrative framework of theories, tools, and competencies. Springer Nature. Moriconi, M., & Carvalho, T. (2016). Social classes and tolerance to corruption in Portugal: What is the relationship?. Portuguese Journal of Social Science, 15(2), 299–318(20). https://doi.org/10.1386/pjss.15.2.299_1 Moser, S., & Côté-Roy, L. (2020). New cities: Power, profit, and prestige. Geography Compass., 15,. https://doi.org/10.1111/gec3.12549 Moser, S., Côté-Roy, L., & Korah, P. I. (2020). The uncharted foreign actors, investments, and urban models in African new city building. Urban Geography. https://doi.org/10.1080/02723638.2021.1916698 Mota, J. C. (2017). Participação dos cidadãos nos Instrumentos de Gestão Territorial. In F.P. Oliveira (Ed.), Ordenamento do território, urbanismo e cidades. Que rumo?, Volume I. Almedina. Moura, B. (2014). Programa POLIS: O caso da cidade da Covilhã [Master’s dissertation, Universidade da Beira Interior]. UBI Repository. https://ubibli orum.ubi.pt/bitstream/10400.6/4918/1/3897_7695.pdf Mourato, J. (2011). Europeanisation and territorial governance: An inquiry into power and institutional culture change in Portugal [Doctoral dissertation, University College of London]. UCL Repository. https://discovery.ucl.ac. uk/id/eprint/1334588/1/1334588.pdf National Health Plan 2012–2016. (2013). Summarised version (May). DirecçãoGeral de Saúde. https://pns.dgs.pt/nhp-in-english/

REFERENCES

175

NVR. National Voluntary Report (2017). Comissão para a Cidadania e a Igualdade de Género Website. https://www.cig.gov.pt/wp-content/uploads/2017/ 07/Portugal2017.pdf NLC. New Leipzig Charter (2020). Adopted at the informal ministerial meeting on urban matters on 30 November 2020. EU2020.DE. European Commission Website. https://ec.europa.eu/regional_policy/sources/docgener/brochure/ new_leipzig_charter/new_leipzig_charter_en.pdf OECD/ European Observatory on Health Systems and Policies. (2017). Portugal: Country Health Profile 2017, State of Health in the EU . OECD Publishing, European Observatory on Health Systems and Policies. https:// doi.org/10.1787/9789264283527-en OECD, EU,. (2018). Health at a glance: Europe 2018: State of health in the EU cycle. OECD Publishing. https://doi.org/10.1787/health_glance_eur2018-en OGC. Oslo Governance Centre (2021). Sustainable development goals. Goal 11. https://www1.undp.org/content/oslo-governance-centre/en/home/ sustainable-development-goals/goal-11-sustainable-cities-and-communities. html Oliveira, A. C. de, Oliveira, F. P., & Batalhão, C. J. (2017). As freguesias em Portugal. Que futuro?. AEDRL. Oliveira, F. P. (2009). Portugal: Território e ordenamento. Oliveira, F. P. (2021). Breves Reflexões sobre a Alteração ao Regime Jurídico dos Instrumentos de Gestão Territorial: O decreto-lei N.º 25/2021 de 29 de Março. Padma, T. V. (2021). COVID vaccines to reach poorest countries in 2023— Despite recent pledges. Nature, 595, 342–343. https://doi.org/10.1038/ d41586-021-01762-w Pazos-Vidal, S. (2019). Subsidiarity and EU multilevel governance: Actors. Routledge. Pedersen, C. B., & Mortensen, P. B. (2001). Evidence of a dose-response relationship between urbanicity during upbringing and schizophrenia risk. Archives of General Psychiatry, 58(11), 1039–1046. https://doi.org/10. 1001/archpsyc.58.11.1039 Perelman, J., Chaves, P., Caldas de Almeida, J. M., & Matias, M. A. (2018). Reforming the Portuguese mental health system: An incentive-based approach. International Journal of Mental Health Systems, 12, 25. https:// doi.org/10.1186/s13033-018-0204-4 Pinker, S. (2015). The village effect: How face-to-face contact can make us healthier, happier, and smarter. Penguin Random House. Pinker, S. (2017, April). The secret to living longer may be your social life [Video]. TED Conferences. https://www.ted.com/talks/susan_pinker_the_secret_to_ living_longer_may_be_your_social_life

176

REFERENCES

Pires, I., & Lange, E. (2019). O PNPOT e os processos de cooperação territorial em Portugal. Public Policy Portuguese Journal, 4(2), 52–67. http://hdl.han dle.net/10362/95071 Plano Nacional de Saúde. (2015). Revisão e extensão a 2020 (Maio). DiecçãoGeral de Saúde. https://pns.dgs.pt/pns-revisao-e-extensao-a-2020/ Plano Nacional de Saúde Mental 2007–2016. (2008). Resumo Executivo (Julho). Coordenação Nacional para a Saúde Mental. Ministério da Saúde, Alto Comissariado da Saúde, Coordenação Nacional para a Saúde Mental. https://www.adeb.pt/files/upload/paginas/Plano%20Naci onal%20de%20Saude%20Mental.pdf Portuguese National Health Plan. (2015). Interim Report on the National Health Plan: Revision and Extension to 2020 (The NHP-Revision) Comments from WHO Europe. World Health Organization. https://www.dgs.pt/ficheiros-deupload-2/pns-evaluation-pdf.aspx PNPOT. (2007). Programa Nacional da Política do Ordenamento do Território (PNPOT). Direcção-Geral do Território. https://pnpot.dgterritorio.pt/ pnpot PNPOT 2020. (2019). Programa Nacional da Política do Ordenamento do Território (PNPOT). Lei n.o 99/2019 de 5 de setembro Diário da República n.o 170/2019. Direcção-Geral do Território. https://pnpot.dgterritorio.pt/ pnpot PNPOT-FI. (2020). Fórum Intersetorial. Programa Nacional da Política do Ordenamento do Território (PNPOT). Direcção-Geral do Território. Resolução do Conselho de Ministros 48/2020, de 24 de junho. https:// pnpot.dgterritorio.gov.pt/pnpot/governacao/forum-intersetorial PORDATA. (2021). Trabalhadores por conta de outrem: total e por nível de escolaridade completo (%.). https://www.pordata.pt/Portugal/Trabalhad ores+por+conta+de+outrem+total+e+por+n%c3%advel+de+escolaridade+com pleto+(percentagem)-2253 Mortensen, P. B., Pedersen, C. B., Westergaard, T., Wohlfahrt, J., Ewald, H., Mors, O., Andersen, P. K., & Melbye, M. (1999). Effects of family history and place and season of birth on the risk of schizophrenia. New England Journal of Medicine, 340, 603–608. https://doi.org/10.1056/NEJM19990 2253400803 Programa Nacional para a Saúde Mental. (2017). Direção-Geral da Saúde Website. Ministério da Saúde. https://www.dgs.pt/portal-da-estatistica-dasaude/diretorio-de-informacao/diretorio-de-informacao/por-serie-885309pdf.aspx?v=11736b14-73e6-4b34-a8e8-d22502108547 Rauhut, D., & Humer, A. (2020). EU Cohesion Policy and spatial economic growth: Trajectories in economic thought. European Planning Studies, 28(11), 2116–2133. https://doi.org/10.1080/09654313.2019.1709416

REFERENCES

177

Reboredo, R. (2021). Disaggregating development: A critical analysis of Sino-African megaprojects. Progress in Development Studies, 21(1), 86–104. https://doi.org/10.1177/14649934211007639 Regulation. (2014). Regulation (EU) No 282/2014 of the European Parliament and of the Council of 11 March 2014 on the establishment of a third Programme for the Union’s action in the field of health (2014–2020) and repealing Decision No 1350/2007/EC. Official Journal of the European Communities, L86/1, 21.3.2014. CELEX number: 32014R0282. https:// eur-lex.europa.eu/ Regulation. (2021). EU Health Plan, EU4HHealth. Regulation (EU) 2021/522. European Commission. https://ec.europa.eu/health/funding/eu4health_en Rio+20. (2012). United Nations Conference on Sustainable Development, Rio+20. RA/RES/66/288. United Nations. https://sustainabledevelopment.un.org/ rio20 Roe, J., & McCay, L. (2021). Restorative cities: Urban design for mental health and wellbeing. Bloomsbury Publishing. Romão, J., & Nijkamp, P. (2019). Impacts of innovation, productivity and specialization on tourism competitiveness—A spatial econometric analysis on European regions. Current Issues in Tourism, 22(10), 1150–1169. https:// doi.org/10.1080/13683500.2017.1366434 Roth, F., Nowak-Lehmann, D., Felicitas, & Otter, T. (2011). Has the financial crisis shattered citizens’ trust in national and European governmental institutions? Evidence from the EU member states, 1999–2010. [Policy Brief] CEPS Papers 4159, Centre for European Policy Studies. https://www.ceps.eu/ RR. Rádio Renascença. (2020, November 27). Portugal continua a “falhar no controlo dos dinheiros públicos”, sobretudo das autarquias. Rádio Renascença. https://rr.sapo.pt/noticia/pais/2020/11/27/portugal-con tinua-a-falhar-no-controlo-dos-dinheiros-publicos-sobretudo-das-autarquias/ 216443/ Sapo (2021, June 28). Licenças habitacionais emitidas pelas autarquias sobem 20,6%. Sapo Notícias. https://casa.sapo.pt/noticias/licencas-habitacionaisemitidas-pelas-autarquias-sobem-20,6/?id=28770 Sasse, T. (2021). Tackling Covid-19 over the long term how to strengthen international efforts to end the pandemic. [IfG Insight] (July). Institute for Government, UK. https://www.instituteforgovernment.org.uk/sites/def ault/files/publications/tackling-covid-long-term.pdf Schipper, S., & Schönig, B. (Eds.) (2016). Urban austerity: Impacts of the global financial crisis on cities in Europe. Theater der Zeit. Scharpf, F. W. (2001). European governance: Common concerns vs. the challenge of diversity. [MPIfG Working Paper] No. 01/6, Max Planck Institute for the Study of Societies. http://www.mpifg.de/pu/workpap/wp01-6/ wp01-6.html

178

REFERENCES

Scharpf, F. W. (2006). Problem solving effectiveness and democratic accountability in the EU . Reihe Politikwissenschaft. Political Science Series 107. Institute for Advanced Studies. http://aei.pitt.edu/6097/1/pw_107.pdf Scholz, N. (2021). Mental health and the pandemic. [Briefing]. European Parliamentary Research Service. European Parliament., Members’ Research Service. PE 696.164 (July). https://www.europarl.europa.eu/RegData/etu des/BRIE/2021/696164/EPRS_BRI(2021)696164_EN.pdf Serricchio, F., Tsakatika, M., & Quaglia, L. (2013). Euroscepticism and the global financial crisis. Journal of Common Market Studies, 51(1), 51–64. https://doi.org/10.1111/j.1468-5965.2012.02299.x Shepard, W. (2017, December 12). Why hundreds of completely new cities are being built around the world. Forbes. https://www.forbes.com/sites/wadesh epard/2017/12/12/why-hundreds-of-completely-new-cities-are-being-builtaround-the-world/?sh=3f721e1514bf Soares, C. (2021, June 2). Costa espera que “país diga sim à regionalização”. Jornal de Notícias. https://www.jn.pt/nacional/costa-espera-que-pais-digaque-sim-a-regionalizacao-13797671.html Soeiro, D. (2019). Gonçalo Ribeiro Telles, b.1922. In S. Ross (Ed.), Routledge Encyclopedia of Modernism. Routledge. https://doi.org/10.4324/978 1135000356-REM2082-1 Soja, E. W. (2010). Seeking Spatial Justice. Minnesota Press. Sokolska, I. (2021). The first treaties [Fact Sheets on the European Union]. European Parliament. https://www.europarl.europa.eu/factsheets/en/sheet/ 1/the-first-treaties Song, C., Ikei, H., Kagawa, T., & Miyazaki, Y. (2019). Effects of walking in a forest on young women. International Journal of Environmental Research and Public Health, 16(29), 229. https://doi.org/10.3390/ijerph16020229 Srivastava, P., Singh, R., Bhadouria, R., Tripathi, S., Singh, H., & Raghubanshi, A. S. (2019). Understanding soil aggregate dynamics and its relation with land use and climate change. In K. K. Choudhary, A. Kumar, A. K. Singh, Climate Change and Agricultural Ecosystems (pp. 331–354). Woodhead Publishing. https://doi.org/10.1016/B978-0-12-816483-9.00021-9 Stockemer, D., & Calca, P. (2013). Corruption and turnout in Portugal—A municipal level study. Crime Law Soc Change, 60, 535–548. https://doi.org/ 10.1007/s10611-013-9481-7 TAEU 2030. (2020). Territorial Agenda for the European Union 2030 (1 December, Germany). Informal meeting of Ministers responsible for spatial planning, territorial development and/or territorial cohesion. https://territ orialagenda.eu/wp-content/uploads/TA2030_jun2021_en.pdf Tavares, A. F., & Sousa, L. de (Eds.) (2018). Qualidade da Governação Local em Portugal. Fundação Francisco Manuel dos Santos. https://www.ffms.pt/pub licacoes/grupo-estudos/2819/qualidade-da-governacao-local-em-portugal

REFERENCES

179

Teles, F. (2012). Beyond paternalism towards social capital: Local governance reform in Portugal. International Journal of Public Administration, 35(13), 864–872. https://doi.org/10.1080/01900692.2012.684194 Teles, F. (2014). Facilitative mayors in complex environments: Why political will matters. Local Government Studies, 40(5), 809–829. https://doi.org/10. 1080/03003930.2013.801835 Local governance and inter-municipal cooperation. Palgrave. https://doi.org/10. 1057/9781137445742.0009 Teles, F. (2020). Public administration in Portugal. In G. Bouckaert & W. Jann (Eds.), European perspectives for public administration: The way forward (pp. 439–452). Leuven University Press. Theodore, N. (2020). Governing through austerity: (Il)logics of neoliberal urbanism after the global financial crisis. Journal of Urban Affairs, 42(1), 1–17. https://doi.org/10.1080/07352166.2019.1623683 TI. Transparency International. (2021). Official Website. https://www.transpare ncy.org/en/countries/portugal Torreblanca, J. I., & Leonard, M. (2013). The continent-wide rise of euroscepticism. [Policy memo]. European Council on Foreign Relations. http:// www.vervinomni.net/euroscepticism.pdf Treaty of Amsterdam. (1999). European Parliament. 2 October 1997. https:// www.europarl.europa.eu/about-parliament/en/in-the-past/the-parliamentand-the-treaties/treaty-of-amsterdam Treaty of Lisbon, (2009). European Parliament. 13 December 2007. https:// www.europarl.europa.eu/about-parliament/en/in-the-past/the-parliamentand-the-treaties/treaty-of-lisbon Treaty of Nice. (2003). European Parliament. 26 February 2001. https:// www.europarl.europa.eu/about-parliament/en/in-the-past/the-parliamentand-the-treaties/treaty-of-nice Treaty of Paris, (1951). European Parliament. 18 April 1951. https://www.eur oparl.europa.eu/about-parliament/en/in-the-past/the-parliament-and-thetreaties/treaty-of-paris Treaty of Rome, (1958). European Parliament. 25 March 1957. https://www. europarl.europa.eu/about-parliament/en/in-the-past/the-parliament-andthe-treaties/treaty-of-rome Treaty on European Union (TEU)/Maastricht Treaty. (1993). European Parliament. 7 February 1992. https://www.europarl.europa.eu/about-parliament/ en/in-the-past/the-parliament-and-the-treaties/maastricht-treaty Tseui, J. J. (1978). Eastern and western approaches to medicine. The Western Journal of Medicine, 128(6), 551–557.

180

REFERENCES

Ulrich, R. S., Simons, R. F., Losito, B. D., Fiorito, E., Miles, M. A., & Zelson, M. (1991). Stress recovery during exposure to natural and urban environments. Journal of Environmental Psychology, 11(3), 201–230. https://doi. org/10.1016/S0272-4944(05)80184-7 United Nations (2018). World urbanization prospects: The 2018 revision, highlights (ST/ESA/SER.A/421). Department of Economic and Social Affairs, Population Division. https://population.un.org/wup/Publications/ Files/WUP2018-Highlights.pdf UNGA, United Nations General Assembly. (2015). Transforming Our World: The 2030 Agenda for Sustainable Development. Draft resolution referred to the United Nations summit for the adoption of the post-2015 development agenda by the General Assembly at its sixty-ninth session. UN Doc. A/70/L.1. https://www.un.org/ UNSD. (2016). Working group on interlinkages of SDG statistics to allow for integrated analyses in the monitoring. United Nations Statistics Division. https:// unstats.un.org/sdgs/files/Working-Group-ToR--Interlinkages.pdf UN-ST. United Nations Statistical Commission. (2019). Interlinkages of the 2030 Agenda for Sustainable Development. Prepared by the Interlinkages Working Group of the Inter-Agency and Expert Group on Sustainable Development Goal Indicators (IAEG-SDGs). Fiftieth session (5– 8 March). https://unstats.un.org/unsd/statcom/50th-session/documents/ BG-Item3a-Interlinkages-2030-Agenda-for-Sustainable-Development-E.pdf UNSTATS. (2021). Global indicator framework for the Sustainable Development Goals and targets of the 2030 Agenda for Sustainable Development. A/RES/71/313; E/CN.3/2018/2; E/CN.3/2019/2; E/CN.3/2020/2; E/CN.3/2021/2. https://unstats.un.org/sdgs/ URBACT. (2021). URBACT – Our partners. https://urbact.eu/our-partners Uslaner, E. M. (2021). Inequality, education and corruption. In A. Bågenholm, M. Bauhr, M. Grimes, & B. Rothstein (Eds.), The Oxford Handbook of the quality of government (pp. 427–446). Oxford University Press. Vassos, E., Pedersen, C. B., Murray, R. M., Collier, D. A., & Lewis, C. M. (2002). Meta-analysis of the association of urbanicity with schizophrenia. Schizophrenia Bulletin, 38(6), 1118–1123. https://doi.org/10.1093/sch bul/sbs096 Vincke, P. (1992). Multicriteria decision-aid. John Wiley & Sons. Wang, X.-R., Chi-Man Hui, E., Choguill, C., & Jia, S.-H. (2015). The new urbanization policy in China: Which way forward? Habitat International, 47 , 279–284. https://doi.org/10.1016/j.habitatint.2015.02.001 Wei, T., Wu, J., & Chen, S. (2021, 12 July). Keeping track of greenhouse gas emission reduction progress and targets in 167 Cities worldwide. Frontiers in Sustainable Cities. https://doi.org/10.3389/frsc.2021.696381 WHO. (2010). Evaluation of the National Health Plan of Portugal (2004– 2010). WHO Regional Office for Europe: Copenhagen. World Health Organization – Regional office for Europe Website. https://www.euro.who.int

REFERENCES

181

WHO. (2011). NCD global monitoring framework. World Health Organization Website. https://www.who.int/publications/i/item/ncd-surveillance-glo bal-monitoring-framework WHO. (2013). Mental health action plan 2013–2020. World Health Organization Website. https://www.who.int/publications/i/item/9789241506021 WHO. (2020). WHO Director-General’s opening remarks at the media briefing on COVID-19-11 March 2020. World Health Organization Website. https:// www.who.int/director-general/speeches/detail/who-director-general-s-ope ning-remarks-at-the-media-briefing-on-covid-19---11-march-2020 Willox, A. C., Harper, S. L., Edge, V. L., Landman, K., Houle, K., & Ford, J. D. (2013). The land enriches the soul: On climatic and environmental change, affect, and emotional health and well-being in Rigolet, Nunatsiavut, Canada. Emotion, Space and Society, 6, 14–24. https://doi.org/10.1016/J.EMOSPA. 2011.08.005 Willox, A. C., Stephenson, E., Allen, J., Bourque, F., Drossos, A., Elgarøy, S., Kral, M. J., Mauro, I., Moses, J., Pearce, T., & MacDonald, J. P. (2015). Examining relationships between climate change and mental health in the Circumpolar North. Regional Environmental Change, 15, 169–182.https:// doi.org/10.1007/s10113-014-0630-z Williams, S., Xu, W., Tan, S. B., Foster, M. J., & Chen, C. (2019). Ghost cities of China: Identifying urban vacancy through social media data. Cities, 94, 275–285. https://doi.org/10.1016/j.cities.2019.05.006 Wilson, R. (2006). Policy analysis as policy advice. In M. Moran, M. Rein, & R. E. Gooding (Eds.), The Oxford Handbook of Public Policy (pp. 152–168). Oxford University Press. WSSD (2002). Draft plan of implementation of the World Summit on Sustainable Development. A/CONF.199/L.1. https://sustainabledevelopment.un. org/milesstones/wssd XXI Governo, República Portuguesa. (2021). Governos anteriores. https:// www.portugal.gov.pt/pt/gc21/governo/governos-anteriores Young, O. R. (2017). Conceptualization: Goal setting as a strategy for earth system governance. In N. Kanie & F. Biermann (Eds.), Governing through goals: Sustainable development goals as governance innovation (pp. 31–51). MIT Press. Yu, H. (2014). China’s “Ghost cities.” East Asian Policy, 6(2), 33–43. https:// doi.org/10.1142/S1793930514000142 ZAP (2021, August 18). Nunca se registaram tantas contratações nas autarquias (e 84% entraram nos quadros). ZAP AEIOU . https://zap.aeiou.pt/contratac oes-autarquias-quadros-425532 Zibanai, Z. (2014). Is the tourism industry a fragile heavy weight? Validation through a Literature Review of Tourism System Shocks. Journal of Tourism Management Research, Conscientia Beam, 1(1), 1–13. https://ideas.repec. org/a/pkp/jotmre/2014p1-13.html