Vol. 2, Number 9 June 2007 (english) - BVSDE - PAHO/WHO

bvsde.ops.oms.org

Vol. 2, Number 9 June 2007 (english) - BVSDE - PAHO/WHO

NEWSLETTER OF THE HEALTH DETERMINANTS AND SOCIAL POLICIES UNIT,

AREA OF SUSTAINABLE DEVELOPMENT AND ENVIRONMENTAL HEALTH, PAHO/WHO

Volume 2, Number 9

June 2007

Healthy Municipalities,

Cities and Communities

Editorial

In this edition

The Participatory Evaluation of the Green and

Healthy Environments Project: drafting intersectoral

public policies in the city of São

Paulo, Brazil

State of the Healthy Municipalities and Communities

Strategy in Argentina in 2006

New PAHO Publication: The Guide to Economic

Evaluation in Health Promotion

Dr. Juan Eduardo Guerrero,

Chief of the Health Determinants

and Social Policies Unit,

PAHO/WHO

This bulletin describes innovative

initiatives that highlight the

progress and experiences of

health promotion in the region

of the Americas. The new

Ibero-American Network of

World Heritage, Universities,

and Healthy Cities brings together

history, culture and

health. The Argentinean Network

of Healthy Municipalities

and Communities invites you to

read its study to measure progress

and establish new challenges

to national and local actors;

Chile illustrates its institutional

commitment to health

promotion in light of new epidemiological

and social realities;

Nicaragua convenes its mayors

through a network that fosters a

culture of health and life; Brazil

describes its advances with participatory

evaluation; and Uruguay

reminds us of the opportunities

offered by productive municipalities

acting to promote health and

development.

Each one of these experiences fills

us with faith, hope and illustrates

many of the lessons learned. It is

as if a new public health was reborn,

a "jet of silver" to travel the

roads of the Americas renewing

the hopes of thousands of social

actors committed to the production

of new ways to generate health;

ways to analyze the causes of the

causes, the health determinants in

each vital space, in each place.

These ways to act are renewed

if people can smile upon knowing

at the beginning of each

day that they can have healthy

food and safe water to consume;

that they can build, live

and sustain a home in a healthy

environment; that they have

access to a school that offers

culture, promotes health, and

contributes to development;

that they have opportunities for

dignified work to feel useful

and productive and, finally, to

enjoy places safe for recreation,

exercise, and culture.

These are the five basic needs

recognized in the laws of life,

in the human rights to which

every human being should

have guaranteed in an equitable

(Continued on page 5)

The Ibero-American Network of World Heritage, Universities and Healthy

Cities is established in Cuenca, Ecuador, with the presence of Dr. Mirta

Roses, Director of PAHO/WHO

Ana Quan, PAHO/WHO, Ecuador

The mayors of Cuenca-Ecuador,

Mompox-Colombia, Guanajuato-Mexico,

Cuenca-Spain,

representatives of the mayors of

Cienfuegos-Cuba, Coro-

Venezuela, with the presence of

the Director of PAHO/WHO,

the President of the Inter-

American Association of Sanitary

Engineering (AIDIS) and

the President of the University

of Cuenca, Ecuador, signed the

Cuenca Declaration, establishing

the Ibero-American Network

of World Heritage, Universities

and Healthy Cities on April 12,

2007, in the city of Cuenca,

Ecuador.

The Declaration states that

cultural heritage, health, and

university constitute an effective

partnership to stimulate

vital and human processes in

cities; the cultural heritage

understood as the memory of

people’s living culture, that is

expressed in various material

and nonmaterial forms and that

brings human beings together. It

is a reflection of the ancestral

Dr. Mirta Roses, Director of PAHO/WHO, in

Cuenca, Ecuador

knowledge, that when interpreted

and recreated by science

(Continued on page 2)

2 Integrating the women of Polanco Yí, Uruguay, to production

and health development policies

3 Health Promotion in the Municipalities of Santiago,

Chile

4 Nicaragua declares its commitment to Healthy Municipalities

4

6

7


The Ibero-American Network of World Heritage, Universities and Healthy Cities is established in

Cuenca, Ecuador, with the presence of Dr. Mirta Roses, Director of PAHO/WHO

(Continued from page 1)

and technology, allows for its conservation

and enjoyment by people today and in future

generations.

The Ibero-American Network emphasizes

the importance of viewing health from multiple

perspectives, as a way of approaching

life, a social practice, a function of the

state, a discipline, an important element for

the construction of citizenship and a responsibility

of municipalities. The mayor

of Cuenca, Ecuador, Dr. Marcelo Cabrera,

declared that a dream had come true and

thanked the valuable support of Dr. Mirta

Roses, Director of PAHO/WHO and other

PAHO staff members, and he welcomed

this historical event for Cuenca and for the

world. "The World Heritage Cities should

lead to a better understanding of the magic

of the past through reviving in current life

ideas and healthy, democratic, equitable,

aesthetic, social and political actions," expressed

the mayor of the city of Cuenca.

Dr. Roses pointed out two interrelated dimensions

among the characteristics of the

Network: that of the university as a generator

of science and culture that represents

the future, and cultural heritage that repre-

sents the past. These two elements are

fundamental in the construction of public

health as was expressed by PAHO/WHO

Director. The Ibero-American Network of

World Heritage, Universities

and Healthy

Cities tries to create a

link among cities of

the different countries

of Ibero-America that

have no more than half

a million inhabitants

and which have been

declared by UNESCO

as World Cultural

Heritage sites and that

work towards improving the health of their

inhabitants and improving their environment,

and those that have universities that

fulfill an important role in the city’s life.

"The World Heritage Cities

should lead to a better

understanding of the magic of

the past through reviving in

current life ideas and healthy,

democratic, equitable, aesthetic,

social and political actions.”

Cities with these characteristics in the region

of the Americas include Potosí and

Sucre (Bolivia); Diamantina, Goiás, Velho,

and Ouro Preto (Brazil); Valparaiso

(Chile); Mompox (Colombia); Trinidad

and Cienfuegos (Cuba); Cuenca (Ecuador);

Salamanca (Spain); Antigua (Guatemala);

Campeche, Guanajuato, and Zacatecas

(Mexico); Cuzco (Peru); Angra de H,

Evora, Cintra, Porto, and Guimaraes

(Portugal); San Juan (Puerto Rico); Sacramento

(Uruguay); Coro (Venezuela). The

objectives of this Network, as the PAHO/

WHO Director expressed, are to build consensus

and alliances and to

foster partnerships among

these Ibero-American cities

to strengthen local development,

health, and university

culture through the sharing of

innovative experiences that

promote collective cooperation

among cities.

The Ibero-American Network

also aspires to promote

solidarity, cooperation, and work relationships

among the cities that comprise the

Network with a view to fostering a generation

of theoretical, political, strategic, and

planning advances that will allow the active

exchange and strengthening of actions

aimed at preserving and developing a city’s

heritage, health, university culture.

For more information on the Ibero-

American Network contact Ms. Ana

Quan (PAHO-Ecuador):

aquan@ecu-ops-oms.org

The Participatory Evaluation of the Green and Healthy Environments Project:

drafting intersectoral public policies in the city of São Paulo, Brazil

Rosilda Mendes*

Daniele Pompei Sacardo*

Maria Luiza Levi*

Márcia Cunha*

Elisabete Agrela de Andrade*

Andréia Setti*

*CEPEDOC Healthy Cities

The city of São Paulo, the principal metropolis

of Brazil, faces great challenges

related to exclusion and social inequalities

that have a considerable impact on urban

and human development processes. The

Green and Healthy Environments Project:

drafting integrated public policies in the

city of São Paulo (GHEP) arose from the

need to implement public policies aimed at

incorporating environmental issues into

actions related to health promotion and the

improvement of the population’s quality of

life, that are implemented by the Family

Health Program (FHP) in the entire territory

of the municipality of Sao Paulo.

This project is based on the broader conceptualization

of health and environment,

and on the possibility of creating mechanisms

to strengthen intersectoral management

at the local level. As a result, the

activities of the FHP propose a plan of action

across the city’s 31 sub-districts and

five regional health departments. This

intersectoral coordination occurs through a

process of education and certification of

nearly 7,000 community health workers,

sanitary control and social protection

agents, and the development of community

projects that take into account local resources

and context.

GHEP Evaluation Design

The evaluation methodology proposed for

the GHEP attempts to integrate qualitative

and quantitative methods and is profoundly

participatory. Participatory evaluation is

based on the central belief that it is necessary

to involve those who are interested in

or affected directly by the evaluation process.

Through a participatory process, a

sense of unity is achieved among those

collaborating. It is a strategy aimed at

producing knowledge and strengthening

social self-analysis, in which the group

learns through reflection on and analysis of

their actions in order to improve future

practice. Thus, the participatory evaluation,

which includes data collection, analy-

(Continued on page 5)

VOLUME 2, NUMBER 9 Page 2


State of the Healthy Municipalities and Communities Strategy in Argentina in 2006

Operational Coordination Unit

Argentinean Network of Healthy Municipalities,

Ministry of Health

As part of its annual procedures, on December

1 2006, the Operational Coordination

Unit of the

Argentinean Network

of Healthy

Municipalities

and Communities

sent out a monitoring

and evaluation

instrument to

different municipalities

that were

members of the

Network, with the

goal of determining

the current

situation of the

Healthy Municipalities

and Communities

Strategy

in Argentina and

to obtain information

concerning

the implementation and development of the

Strategy in the country. The instrument

explored the following areas: participation,

healthy public policies, evaluation of

local participatory projects, difficulties

encountered in the development of the

HMC Strategy at the local level, and communication

in the Network.

Of the 183 healthy municipalities that

formed the Network at the time, 64 (35%)

replied to the survey. Below, the results

obtained are described:

• 84% of the municipalities conducted

a participatory assessment with the

community.

• The issues identified in these assessments

are equally distributed across

three theoretical categories:

"identification of risk factors for

health," "identification of groups at

risk" and "social determinants of

health and health promotion." The

first category was more prominent by

5% than all the others.

• 87% of the municipalities have approved

ordinances that legalize the

HMC Strategy.

GRAPH 1: Distribution of themes

identified in the participatory

assessments conducted - N/64,

2006

32% 37%

31%

• A strong relationship (80% average)

was found between the topics identified

in the participatory assessments

and municipal political commitment

for addressing them.

• 53% of the municipalities have committed

resources to the HMC Strategy,

48% are

Identification of Risk Factors

for Health

Identification of groups at

risk

Social Determinants of

Health and Health Promotion

• 111

(one hundred

and

eleven) local

participatory

projects

were evaluated.

assigned to

human resources,

29% to

physical

resources,

and in 29%

of the cases,

the budget is

exclusively

assigned to

the HMC

Strategy.

• The municipalities requested support

to create more opportunities for intraregional

and interregional meetings,

workshops on specific health

promotion topics and for sharing experiences.

• Concerning the benefits of being

members of the Argentinean Network

of HMC, the municipalities men-

GRAPHIC 2: Relationship between topics identified

in the participatory assessment and municipal ordinances

approved N/64, 2006

200

15

0

100

50

0

Participatory

Assessments

Public

Policies

I

I

I

III

I II II

174 140 145 I

140 96 142

tioned increased possibilities for dissemination,

communication, and access

to information; technical assistance

and/financing; and opportunities

to create new social networks.

Fifty-nine percent of the municipalities

mentioned "improved quality of

life of the population," as an added

value of belonging to the Network.

The most important difficulty encountered

was related to strengthening actions taken

through the HMC Strategy, which highlights

the need to intensify activities aimed

at improving human resources, and to

increase investment in human, physical,

and/or material resources in order to guarantee

sustainability of the actions taken.

Nevertheless, some municipalities emphasized

their difficulties in sustaining community

participation.

The survey demonstrates a high level of

demand for technical assistance, specifically

in aspects related to project design

and management, follow-up, and monitoring

and evaluation of local interventions,

as well as related to tools for the documentation

of experiences. Needs for

more financing were also expressed.

The complete report of the evaluation is

available online through the website

http: /municpios.msal.gov.ar/upload/

publications/Publicaciones_99.pdf.

For more information on the Argentinean

Network of Healthy Municipalities

and Communities consult the following

website: http: /municipios.msal.gov.ar/

Participatory

Assessments

Public Policies

References for Graph 2

I. Identification of risk factors

II. Identification of groups at

risk

III. Social Determinants of

Health and Health Promotion

VOLUME 2, NUMBER 9 Page 3


New PAHO Publication: The Guide to Economic Evaluation in Health

Promotion

Reinforcing its commitment to the evaluation

of health promotion effectiveness, the

Pan American Health Organization (PAHO)

launches this month a new publication, the

Guide to Economic Evaluation in Health

Promotion. This publication is the result of

a joint effort between several institutions,

academia, and decision-makers, among

them PAHO, the Center for the Development

and Evaluation of Policies and Technologies

in Public Health (CEDETES) of

the University of Cali, Colombia; the Center

for Health Promotion of the University of

Toronto, Canada; the University of Calgary,

Canada; the National School of Public

Health, in Cuba; and the Centers for Disease

Prevention and Control (CDC).

The objective of the Guide to Economic

Evaluation is to provide information of use

to managers and policy makers who must

decide where best to allocate society’s

scarce resources. In general, an economic

evaluation helps to decide the effectiveness

of allocating financial, human and other

resources to a particular intervention. In

the health field, an economic evaluation

concentrates on measuring the costeffectiveness

and the cost-benefit of clinical

and preventive interventions, for example,

vaccinations and cholesterol reducing

drugs. However, this approach is not applicable

to the field of the health promotion,

since it addresses multiple objectives

beyond health gains. Central to the definition

of health promotion is individual, organizational

and community empowerment

so that each is prepared to promote and

maintain health. This is important in order

to sustain the effectiveness of the

health promotion programs after the initial

investment and the implementation of the

program. As a result, capacity-building is

a fundamental objective in health promotion.

Another important characteristic of

health promotion is its focus on the social

determinants of health. Just as many of

these determinants are outside the scope of

the health sector (education, housing,

transportation, etc.), so too is the responsibility

of health promotion. And since

these determinants of health interact and

affect health in many different ways,

health promotion strategies must also include

multiple components.

It is also necessary to consider that health

promotion involves various actors and acts

at different levels of society. All these

factors demonstrate the greatest complexity

of economic evaluation in the health

promotion field. Health promotion is inevitably

of a social and political nature.

Furthermore, its focus on equity and the

determinants of health means that the

evaluation of health promotion policies

and programs must be based on information

not only about changes in health con-

(Continued on page 9)

Integrating the women of Polanco de Yí, Uruguay, to production and health

development policies

Dr. F. Dora, Mag. M. González, Soc. F.

Pintos y Dr. R. Salvatella, PAHO-

Uruguay

The municipal government of Florida, the

Departmental Health Bureau, the Uruguayan

Bee Society, and PAHO/WHO,

launched on 17 April 2007 a project

framed within the Healthy and Productive

Communities Strategy. Polanco de Yí, in

the center of the country, is one of the

populations most detached from state and

municipal policies, expressing various

forms of exclusion: territorial (space not

within relevant communication channels);

social (weak connection to systems of social

organization); economic (lack of work

opportunities for local labor force); symbolic

(territory with little attraction for

public policies with highly productive results);

gender (lack of employment, isolation,

limitations due to the way roles are

designated within families, and lack of

material and symbolic incentives).

The goal is to provide social and economic

sustainability, integrating a group of pollen

collectors into the production system

through a commitment to healthy practices.

The activity will be carried out in surrounding

apiaries located on the banks of rivers

and streams that have native flora. Pollen

is one of the by-products of beehives of

least interest to the producers

due to the low

cost–benefit ratio that

its extraction implies.

About 90% of what is

locally marketed is imported;

and it is of a

quality that could be

improved if it were to

be produced locally.

This situation is shared

by the producers of the

micro-region where

Launching of the program by Mr. Juan

Polanco de Yí and Giachetto, Mayor of Florida, Uruguay.

Sarandí Grande are

located. It is an area rich in the quality of

honey and the pollination of fields gener-

ated by this type of production.

Beekeepers of that region could absorb a

limited group of women as salaried labor, to

extract pollen and prepare it for market.

The goal of this initiative is to improve

health conditions and income level of the

women of Polanco de Yí, through an experience

that integrates

productive activities

and health policies

through:

• Training women as

pollen collectors.

• Providing structure

to give sustainability to

the intervention.

• Integrating into

local health strategies.

• Implementing the

Ministry of Public

Health’s program for

(Continued on page 6)

Page 4

HEALTHY MUNICIPALITIES, CITIES AND COMMUNITIES


The Participatory Evaluation of the Green and Healthy Environments Project:

drafting intersectoral public policies in the city of São Paulo, Brazil

(Continued from page 2)

sis of and reflection on the various components

related to the development of the

process being evaluated, provides the essential

elements for its own monitoring.

In the methodological design proposed, this

"continuous feedback"

on the

evaluation process

should be permanently

integrated

into the evaluation.

By highlighting

joint reflection, the

evaluation helps to

create a pact to

develop actions

directed at the continuous

monitoring

process, which in

turn, facilitates its implementation. In the

evaluation process, all the activities carried

out in the project should be registered,

whether by means of instruments elaborated

previously or through strategies that

assess the perceptions of those involved.

The suggestions are incorporated in each

one of the stages, with the objective of

solving problems that were not taken into

account during the planning stage, and determining

whether the activities can potentially

achieve the expected results. Thus,

“Participatory evaluation is based

on the central belief that it is

necessary to involve those who are

interested in or affected directly

by the evaluation process.

Through a participatory process,

a sense of unity is achieved

among those collaborating.”

recommendations are made at the conclusion

of each step in order to incorporate

any necessary changes and identify future

goals to be achieved by the project.

Participatory techniques are used to facilitate

an approach to getting people to think,

clarify doubts, and express different points

of view and perspectives.

It is an evaluation

aimed at correcting

mistakes and making

adjustments, and at

creating an impact on

daily operational decisions

in order to determine,

qualitatively, the

degree of change produced

in the process

and to promote the

involvement of the

relevant actors. The

process of participatory evaluation presupposes

that: (1) the design of the evaluation

is agreed upon by different actors; (2) the

abilities and knowledge generated are

shared among all participants; (3) there is a

continuous feedback and reflection process,

and, (4) a diversity of actors are involved in

the evaluation.

With the goal of providing orientations for

the participatory evaluation process, particularly

with regard to the completion of

each stage and its activities, the Evaluation

Working Group (WG) was created with

representatives of several segments of the

project (approximately 10 people). This

WG meets monthly and its objectives are

to: a) institutionalize the participatory

evaluation and monitoring process; b)

reflect on the evaluation process and its

linkages with the project’s development; c)

contribute to the dissemination and communication

of the issues related to the project’s

evaluation and monitoring among

those involved; d) help guarantee support

for the evaluation and monitoring process.

The results of the evaluation and monitoring

have contributed to improvements in

the project’s management, as well as in

those processes related to improving capacities

of educators and community health

workers. Furthermore, the results have

highlighted the need to monitor the social

networks that have been formed to help

develop local intervention projects that

incorporate health promotion and socioenvironmental

sustainability perspectives.

For more information on this project

contact Dr. Rosilda Mendes

(rosilda@usp.br) or Dr. Daniela Sacardo

(danipsac@usp.br).

Editorial (continued)

(Continued from page 1)

society focused on generating physical,

mental and spiritual health.

In the 21 st century public health is renewed

by forging new intersectoral partnerships

that are focused on analyzing the determinants

of health and on incorporating other

strategies such as primary health care and

health promotion. Both offer synergistic

elements that help in the achievement of

the Millennium Development Goals as

well as in facilitating processes that address

new challenges to preventing chronic

non-communicable diseases, violence,

drug addictions and HIV-AIDS.

All these new challenges require us to address

psychosocial, nutritional, and environmental

determinants in order to promote

changes aimed at achieving human

safety and health.

For all of the above, a constructive dialogue

between the State and society is necessary

in order to design interventions that

address a myriad of realities in significantly

different gender and cultural contexts.

New voices that facilitate citizen

empowerment and participation are necessary,

as is a citizenship that speaks and is

listened to by its democratically elected

authorities.

A citizenship is emerging that speaks and

acts to transform its family and community

environment, demonstrating to authorities

that changes are possible if only they respond

to their constituent’s interests and

work towards improving social wellbeing,

along with jointly working towards a new

society that values life and orients the generation

of income and production. As such

it is possible to build and generate public

and socially coherent policies in the context

of the globalization of culture and the

economy.

VOLUME 2, NUMBER 9 Page 5


Integrating the women of Polanco de Yí, Uruguay, to production and health

development policies

(Continued from page 4)

woman and gender.

• Strengthening state agencies in the

region.

• Generating conditions for stable pollen

production.

The phases of this project include:

• Strengthening the group, providing

access to health programs, and negotiating

with bee producers for the inclusion

of women as salaried workers.

• Training (beekeeping, collection of

pollen, organizing the work, income

management and community health

workers).

• Integrating women into the productive

process, evaluating the process and including

women in the workforce; access

Groups of Women from Polanco de Yí

to education and primary care.

• Strengthening the project: training in

bee production so that the producers are

independent and local health campaigns are

spearheaded by women as community

agents.

• Generating sustainability for the

initiative: evaluation of the experience

in partnership with the producers

and women, decision-making about

the extent of the project, maintenance

of the employment source, and local

health impact assessment resulting

from the inclusion of women into the

Ministry of Public Health’s health

policies.

This local intervention intends to impact

on the generation of local resources,

strengthening community

social capital, improving conditions of

local governance, empowering excluded

social sectors and incorporating

women into health policies.

For more information on this project

contact Mr. Mario Gonzalez

(gonzalem@uru.ops-oms.org) or Dr.

Roberto Salvatella (salvater@uru.opsoms.org)

Health Promotion in the Municipalities of Santiago, Chile

Gerardo Herrera Latorre, Chief of the

Health Department, Public Health Secretariat,

Metropolitan Region, Chile.

Nolvia Valdes Gonzalez, Adviser for the

Department of Public Health, Health

Secretariat, Metropolitan Region, Chile.

Due to health system reform in Chile, the

Health Secretariat of the Metropolitan

Region (SEREMI), together with a team

of health, education and social work professionals,

implements public policies

that have as a priority health promotion

and citizen participation. This is carried

out within the range of responsibilities of

the Health Authority 1 out of the 15 regions

in which 6,527,903 inhabitants

(40.7% of the country) lives.

Health promotion has been a national

public policy for 10 years, consolidated

through strategic guidelines which support

specific financing that is transferred

from the health sector to the municipalities

to formulate and carry out health promotion

plans. The SEREMI has designed

orientations for the formulation of

health promotion plans in the 52 municipalities

of the region, hoping to advance

health promotion, citizen participation, and

intersectoral work through community Vida

Chile Committees.

The municipalities formulate plans with

community participation and design projects

to be carried out with government financing.

At the local level, the management of intersectoral

local funds to support the Community

Plan is encouraged, including the community,

universities, other institutions,

NGOs, private companies and others. For

the year 2007, the municipalities will receive

the equivalent to US $900,000.00, as

their annual state contribution, which is an

increase of approximately 4% with respect

to the previous year. This contribution is

distributed to municipalities according to

criteria such as rural setting, poverty, gender,

ethnic groups, life cycle, and vulnerability.

Chile is going through a demographic and

epidemiological transition. The main

causes of death are strongly linked to lifestyles

and aging: circulatory system, malignant

neoplasms, and accidents. Life

expectancy is estimated in 73 years for men

and 79 for women. In men, the prevalence

of smoking is 44% and in women is 36%.

Among women a sedentary lifestyle is

higher, estimated in 89%. The prevalence

of obesity among children under 6 is 7.2%.

At the age when children start school obesity

is estimated around 18.5% and in pregnant

women it is 32% 2 . In relation to

workers' health, deficiencies are found in

the area of disease prevention and workrelated

accidents. There is high awareness

of problems related to the physical environment,

especially related to community

infrastructure, contamination, and hygiene.

The existence of spillways from solid

waste is observed in the rural areas, along

with poor management of industrial and

household waste.

Health promotion is aimed at achieving

healthy settings that allow for people,

families, social organizations, and institutions

to commit themselves to promoting

health and improving living and environmental

conditions. Actions are directed to

achieving Healthy Municipalities and

Communities, Healthy Workplaces, and

Health-Promoting Schools.

They also highlight actions implemented in

(Continued on page 7)

VOLUME 2, NUMBER 9 Page 6


Nicaragua declares its commitment to Healthy

Municipalities

Mr. Eduardo Ortiz, PAHO-Nicaragua

On March 2 2007, in the city of Managua,

the mayors of the Managua Association

of Municipalities (AMUDEM), the

National Association of Municipalities

(AMUNIC) and the Ministry of Environment

and Natural Resources

(MARENA), with the support of the Pan

American Health Organization (PAHO)

in Nicaragua, held the Forum for Healthy

Municipalities and Communities with the

participation of mayors from other departments

of the country.

The forum was also attended by the

mayor of Cotacachi, Ecuador, Mr. Auki

Tituaña, and the Mayor of Coscomatepec,

Veracruz, Mexico, Mr. Ignacio Álvarez,

and Mrs. Rosa Adelina Rivas of

the Municipality of San Juan South, in

Nicaragua. They all presented the work

of their municipalities to promote the

health of their populations.

It is important to emphasize the achievements

of the municipalities in the development

of municipal development plans

with broad citizen participation, and the

implementation of actions that have impacted

positively on indicators of population

health. Highlighted among the

most important achievements were:

• Political decision of the local government

to promote decentralization.

• Institutionalization of the Intersectoral

Health Council.

• Operation of local health committees.

• Formation and strengthening of the

Management Committee for free

maternity care.

• Development and training of User

Committees.

• Training and environmental information

system under development.

• Incorporation of alternative health

practices in the local development

process.

• Coordination of the health services

network with that of the traditional

medicine system (midwives, traditional

healers, community agents).

In this context, mayors and national

Mayors (Ecuador, Mexico, Nicaragua), nacional

authorities and PAHO/WHO representatives.

authorities of Nicaragua prepared a declaration

in favor of the Healthy Municipalities

initiative that begins by stating:

“We: Authorities of the Ministry of Environment

and Natural Resources, of the

Ministry of Health, elected representatives,

autonomous government entities,

mayors, and vice mayors, as members of

the Managua Association of Municipalities

(AMUDEM) declare our political

will in committing to the Healthy Municipalities

and Communities Strategy

(HMC) and allocate, in accordance with

our resources, capacity for management

and competences, to strengthen municipal

governments so that they are incorporated

into this strategy, promoted by

PAHO/WHO, AMUNIC, and CJA.”

In order to support this process that is

growing at the national level, PAHO in

Nicaragua has formed a common strategy

of cooperation among the areas of Policy

Development, Health Services, and Sustainable

Development and Environmental

Health for the purpose of implementing

actions to advocate for health, environment

and its determinants at the local

level, in accordance with its abilities and

advocating for the creation and strengthening

of the National Network of Healthy

Municipalities and Communities (HMC).

The event was attended by the Minister

of the Environment, Ms. Amanda Lorio;

the AMUNIC Executive Secretary, Dr.

Patricia Delgado; the Representative of

PAHO/WHO in Nicaragua, Dr. Socorro

Gross; and authorities of the Ministry of

Health, among others.

For more information on this event,

contact Mr. Eduardo Ortiz (PAHO-

Nicaragua): ortized@nic.ops-oms.org

Health Promotion in the

Municipalities of Santiago,

Chile

(Continued from page 6)

the health facilities themselves, as well as

in social organizations and private institutions.

The Community Health Promotion

Committees (Vida Chile) should contribute,

through their plans, to the achievement

of the goals of the Regional Public Health

Plans, through the following components:

• Food and nutrition (food, obesity and

sedentary lifestyle)

• Tobacco

• Healthy and safe environment (water,

chemicals, air, refuse and waste)

• Zoonosis and vectors

• Healthy workplaces

• Accidents, violence, alcohol and drug

abuse

• Reproductive health

• Social participation and intersectoral

collaboratoin

• Development of regional capacities.

Challenges for 2007

Among the challenges for the year 2007

the following can be highlighted:

• Incorporate the Social Determinants

and Equity Approach in the development

of health promotion and

quality of life.

• Ensure the development of strategies

that have been proven to be

effective in order to meet the national

2010 targets.

• Advance healthy public policies,

with effective intersectoral coordination

and citizen participation.

For more information contact Mr.

Gerardo Herrera:

gerardo.herrera@asrm.cl

Footnotes:

1 Law 19.937 of the Sanitary and Management

Authority.

2 Presentation by the Minister of Health.

Progress on the Impact Objectives. Ministry

of Health, 2006.

VOLUME 2, NUMBER 9 Page 7


Which countries are implementing the Healthy Municipalities, Cities and

Communities (HMC) Strategy in the Region of the Americas?

Currently, 19 of the 35

countries and 3 territories of

the Region of the Americas

are actively involved with the

Healthy Municipalities,

Cities and Communities

Strategy

Countries implementing the HMC Strategy

and with national or regional HMC networks

established.

Countries implementing the HMC Strategy

Countries not implementing the HMC

Strategy

VOLUME 2, NUMBER 9 Page 8


NEWSLETTER OF THE HEALTH

DETERMINANTS AND SOCIAL POLICIES

UNIT, AREA OF SUSTAINABLE

DEVELOPMENT AND ENVIRONMENTAL

HEALTH, PAHO/WHO

525 23rd St, NW

Washington, DC

20037

www.paho.org

This newsletter is a trimestral publication of the Health Determinants and Social

Policies Unit, Area of Sustainable Development and Environmental Health,

PAHO/WHO. The content can be reproduced, as long as the source and author(s)

are cited.

Dr. Luiz A. Galvão, Area Manager, Area of Sustainable Development and Environmental

Health

Dr. Juan Eduardo Guerrero, Chief of the Health Determinants and Social Policies

Unit

Marilyn Rice, Regional Adviser for Healthy Municipalities, Cities and Communities

Editor: Maria Cristina Franceschini, Consultant

Send your suggestions, questions and comments to: francesm@paho.org and

ricemari@paho.org. To submit articles for publication in this bulletin, please

contact Maria Cristina Franceschini (francesm@paho.org) and Marilyn Rice

(ricemari@paho.org).

Website: www.bvsde.paho.org/municipality

To subscribe to the listserv of the Network of Healthy Municipalities, Cities and

Communities of the Americas:

http://listserv.paho.org/archives/carib-hmc.html

New PAHO Publication: The Guide to Economic Evaluation in Health

Promotion

(Continued from page 4)

ditions and their risks, but also about

health promotion’s ability to build individual,

collective and institutional capacity

to participate in decisions that affect

health and welfare.

Up to now, guides on economic methods

to evaluation were focused on clinical and

health care settings, with some guides

addressing the economic evaluation of

health promotion. However, their approaches

are centered on relatively simple

interventions. There is little available

information on the practical aspects associated

with the economic evaluation of

more complex health promotion interventions.

In order to close this gap, a group of

experts in health promotion, health economics,

and economic evaluation took on the

task of developing this Guide to Economic

Evaluation in Health Promotion.

The Guide is structured in 5 main sections

that describe in detail the steps necessary for

conducting an economic evaluation. Case

studies are used to illustrate each stage of

the process. Technical notes are provided

as additional material for readers who are

interested in learning more about a specific

subject. In addition, the Guide includes a

glossary of the most common terms in the

field of economic evaluation.

The Guide to Economic Evaluation was

designed especially for health promotion

professionals and decision-makers. It is

also expected that the Guide will be useful

to those in charge of management,

implementation, and evaluation of health

promotion strategies, and to those interested

in advocating for health promotion.

Finally, the Guide can serve as a teaching

tool in public health education.

For more information on the Guide to

Economic Evaluation contact Ms.

Marilyn Rice (ricemari@paho.org).

Page 9

HEALTHY MUNICIPALITIES, CITIES AND COMMUNITIES

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