pan american health organization regional office for the world health organization

Pan American Health OrganizationRegional Office for the

World Health Organization

Celebrating 100 Years of Health

Creating HEALTHY AND SUPPORTIVE Environments: the settings approach in health promotion

Organización Panamericana de la Salud • http://www.paho.org

Two starting points of a new dynamic

z Health

z New and expanded role of health in modern societies and in developing countries that are much less health care system centered

z Governance

z New approaches to governance in all societal systems and at all levels of governance that are much less state centered


New realities for policyz Changing role of governments and institutionsz Changing demands on leadershipz New pluralism of interestz A new view of political and social responsibilities

z Search for new models of organization and financing of social security, welfare and health


21st Century: Change in governance

z 21st century governance characteristics:

z public philosophy based on equity

z participatory value base

z new ecology of collaborationz OECD Report

Pan American Health Organization • http://www.paho.org

The Concept of SettingsThe Concept of Settings

A setting is the context within which and through which health is produced

Powerful methodological tool Provides a framework for understanding and

identifying the protective factors (physical and social) that contribute to health, quality of life and sustainable development

“Health behavior and health outcomes are products of their unique environments” (I. Rootman and M. Goodstadt)


The Importance of SettingsThe Importance of Settings

Promote health and protect life, together with people and communities, in settings where they study, live, love, work, study and play

Context and structure for behaviors and lifestyles Grounds the analysis, understanding and contribution to

improving the determinants of health and equity Settings vary widely

Large complex communities - municipalities, cities Smaller discrete organizational units - schools, workplaces,

marketplace, homes Combination of Health Promotion strategies and intersectoral

approaches


Healthy Municipalities and Communities

Prevention

Promotion

Workplace Integrated

strategies

Homes

Marketplaces

Safe

communities ContinuityParticipation

Schools

Communication

Hospitals


Healthy Municipalities – Healthy Cities

A municipality begins the process of becoming healthy when its political leaders, local organizations, and citizens commit themselves to improving the health and quality of life of all of its inhabitants – A plan of action with health targets

Establish and strengthen a social pact among local authorities, community organizations, and public and private sector institutions

Use local planning and social participation in management, evaluation, and decision-making


Healthy CommunitiesCantones Saludables

Healthy Workplaces

Health Promoting Schools

Healthy Cities

Comunidades Saludables

Builds and strengthens a Builds and strengthens a social pact among key players social pact among key players to promote health with people to promote health with people and their communitiesand their communities

Local Authorities

Community Organizations

Healthy Barrios

Health Sector


Healthy Municipalities and Healthy Municipalities and CommunitiesCommunities

Mayors lead and facilitate joint planning with all relevant sectors and consensus building on the local priorities, policies and strategic actions to improve health and quality of life with equity

A plan of action based on a participatory needs assessment and the analysis of the determinants of health in each setting

Establishing communication among all stakeholders and for the public to share information on activities, progress, meetings, etc.

Implement models based on country experiences and sound public health and health promotion theory and practice


Priorities in the US/Mexico Border

Water Sanitation Waste disposal Recycling Protection of natural

resources Environmental

education

Environmental Health and Housing


WHY IS HMC STRATEGY EFFECTIVE?

Creates strong alliances among local authorities, community leaders and diverse public and private sectors

Promotes active citizen participation Creates dialogue and mutual sharing of knowledge and

experiences Supports democratization and decentralization of

decisions and resources Strengthens capacity and provides an ordering

mechanism


Healthy Cities 1986……


Adopción de la Estrategia de Adopción de la Estrategia de Municipios por la Salud en México Municipios por la Salud en México

1995-20001995-2000

Mexico

1995

2000

0

200

400

600

800

1000

1200

1400

1600

1995

2000


The Pillars of HMC: the Ottawa Charter

Establishing healthy public policies Responding to local priorities by involving all

stakeholders: empowering, developing skills and building capacity

Creating supportive and sustainable environments Incorporating collaboration from multiple sectors and

partners Creating systems changes through process and outcome

modifications - reorienting services


Settings approach

What can your sector do to create health?

What can the health sector contribute to your goals


Key strategic questions

What creates health and well-being? How well are we addressing major determinants of health?

Which investment creates the highest well being? Which of the determinants should we address as a priority (given a set of technical as well as political criteria in order to assess feasibility)?



Does this investment reduce the health gap and ensure human rights?

Will the disadvantaged and vulnerable populations be involved in developing the strategies and approaches?

Will policy makers be willing to follow up the community based recommendations?



Does the health investment contribute to overall community well being? How will we account for the use of resources? What type of measures will we use?


PHASES OF THE STRATEGY (1)

INITIAL AND ORGANIZATIONAL PHASE (1 to 3 months):

Expected Outcome: An Approved HMC Action Plan

Conduct a participatory community-based assessment

Create an intersectoral and municipal committee and develop an overall common vision of HMC

Develop a proposed action plan with health targets through a participatory and intersectoral process

Ensure assignment of resources for the plan by the Municipal Council

Discuss and disseminate the approved plan through a public forum



PLANNING PHASE (4 to 6 Months)

Expected Outcome: A Working Group and Detailed Work Plan

Ensure representation of members of the Intersectoral Municipal Committee and of a working group for activity implementation and monitoring

Develop a detailed work plan with activities, assigned responsibilities and resources, a timeline, and indicators for monitoring and evaluation

Identify strategies to encourage sustained participation and partnerships for the implementation of the plan and resource mobilization



ACTION PHASE (2-3 years and beyond):

Expected Outcome: A Healthy Municipality and Community

Promote local healthy public and institutional policies, and intersectoral actions, gap analysis, advocacy, public debate

Develop a policy framework and infrastructure to support and sustain the implementation of the Healthy Municipalities and Community strategy

Create a range of healthy spaces, schools, workplaces

Encourage politicians and other decision-makers to commit themselves to community capacity-building, strengthening the HMC Strategy and ensuring its sustainability and intersectoriality


The Mayor’s KitPromoting health and quality of life

Guidelines to initiate the process following the three phases

Technical information fact sheets on priority public health programs

Orientation guidelines

Quick reference brochure

Informative page


Lessons Learned

National supportive technical unit and teams

Local leadership and investment

Effective policy and programs Engaging academic

institutions in training, research, development, and evaluation

Strengthening information and surveillance, indicators

Networks and networking


HomesSchoolsWorkplacesMarketplacesHospitalsSlumsParksStreets

Lessons LearnedSupportive environments sustain behavior change

Life Skills Education


Lessons LearnedDeveloping skills and competencies

Capacity building and strengthening community action

Nurturing leadership• Health Literacy• Communication• Health Education


Production of health?

A society that spends so much on health care that it cannot or will not spend adequately on other health enhancing activities may actually be reducing the health of its population.”

Evans/Stoddart 1996


The evidence is overwhelming

Health promotion strategies Healthy public policy Working in partnerships Citizen involvement and community

participation Empowerment Capacity building and training Intersectorial planning and action Information, surveillance and evaluation Public education and communication Continuity Democracy

Matamoros

San Diego

Brownsville

El Paso/Cd.Juarez

Tijuana


Characteristic of settings networks

Loose governance

Innovation

Adaptability

Learning capacity

A new space for health

Pan American Health OrganizationRegional Office for the

World Health Organization

Celebrating 100 Years of Health

Thank you very much

pan american health organization regional office for the world health organization

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