About 40% of people in the Western Pacific Region live in urban areas, and it is expected that the percentage will reach 50% a few years after 2010 .The rapid rate of urbanization particularly since 1980 has brought about changes in physical and social determinants of health. Similarly, small island countries in the Pacific have undergone socio-economic development, affecting often adversely the fragile physical environment and social lives and lifestyles of the island people.
Effectively addressing health issues in urban areas and islands has become complex, and solutions require not only the improvement of the health sector's services, but also changes in the way that the health sector works with other sectors as well as with the community and individuals.
To deal with health problems in urban areas and islands, particularly in developing countries, WHO embarked on a regional Healthy Cities-Healthy Islands programme in the mid-1990s. Currently some 170 cities and towns in the Western Pacific Region are implementing Healthy City projects. Of these projects, WHO has supported the development of 18 projects in Cambodia, China, the Lao People's Democratic Republic, Malaysia, Mongolia, the Republic of Korea, the Philippines and Viet Nam.
With respect to Healthy Islands, the Ministers for Health of the Pacific have met three times in Fiji, Cook Islands and Palau. They are fully committed to the principles of Healthy Islands. Countries have begun operationalizing the principles and searching for effective ways to implement Healthy Islands activities.
Smaller, yet better defined, physical and social settings (often called elemental setting), such as schools, workplaces, marketplaces, hospitals, villages / communities, have been used to focus on health protection and health promotion activities. Health-promoting schools are implemented in most countries and areas in the Western Pacific Region, and networks are being formed to support the sharing of information and experiences. Model projects for other elemental healthy settings are being developed in various developing countries.