The logic of method for evaluating healthy cities

It is important to evaluate and assess the workings and results of Healthy Cities. However, as Healthy Cities are conceptualized beyond ‘standard’ urban health initiatives that can be mapped with the repertoire of epidemiological techniques, an approach to generating evidence in this field must necessarily be complex and interactive. This chapter describes why and how monitoring, evaluation and assessment for Healthy Cities are important and what the evidence generated should be able to tell the different stakeholders in and beyond an individual Healthy City. The diversity of these functions must be embraced by a conscientiously developed ‘logic of method’ (methodology)—which for Healthy Cities is a negotiated and flexible effort. Two conceptual frameworks are presented that enable this: Fourth Generation Evaluation and Realist Synthesis. A long case study is presented on the negotiation, development and implementation of a Realist Synthesis evaluation of Phase V of the European WHO Healthy Cities Network, which involved 99 cities across dozens of constituencies—but with very high response rates and significant perceived relevance among stakeholders ranging from communities to WHO officers. This review argues that more attention needs to be paid to issues of resourcing, planning, timing and negotiating interactive methodologies for value-based urban health endeavours.