Pan American Health Organization Regional Office for the World Health Organization

1. Pan American Health Organization Regional Office for the World Health Organization Creating HEALTHY AND SUPPORTIVE Environments: the settings approach in health promotion Celebrating 100 Years of Health

2. Health New and expanded role of health in modern societies and in developing countries that are much less health care system centered Governance New approaches to governance in all societal systems and at all levels of governance that are much less state centered Two starting points of a new dynamic

3. New realities for policy • Changing role of governments and institutions • Changing demands on leadership • New pluralism of interest • A new view of political and social responsibilities • Search for new models of organization and financing of social security, welfare and health

4. 21st Century: Change in governance • 21st century governance characteristics: • public philosophy based on equity • participatory value base • new ecology of collaboration • OECD Report

5. The 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)

6. The 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

7. Healthy Municipalities and Communities Prevention Integrated strategies Homes Workplace Communication Participation Continuity Safe communities Marketplaces Schools Promotion Hospitals

8. 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

9. Builds and strengthens a social pact among key players to promote health with people and their communities Comunidades Saludables Cantones Saludables Healthy Communities Health Promoting Schools Healthy Cities Healthy Barrios Healthy Workplaces Community Organizations Local Authorities Health Sector

10. Healthy Municipalities and Communities • 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

11. Priorities in the US/Mexico Border Environmental Health and Housing • Water • Sanitation • Waste disposal • Recycling • Protection of natural resources • Environmental education

12. 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

13. Healthy Cities 1986……

14. Adopción de la Estrategia de Municipios por la Salud en México 1995-2000 2000 1995

15. 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

16. Settings approach • What can your sector do to create health? • What can the health sector contribute to your goals

17. 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)?

18. Key strategic questions • 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?

19. Key strategic questions • · 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?

20. 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

21. PHASES OF THE STRATEGY (2) 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

22. PHASES OF THE STRATEGY (3) 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

23. 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

24. 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

25. Lessons Learned Supportive environments sustain behavior change Homes Schools Workplaces Marketplaces Hospitals Slums Parks Streets • Life Skills Education

26. Lessons Learned Developing skills and competencies Capacity building and strengthening community action Nurturing leadership • Health Literacy • Communication • Health Education

27. 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

28. 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 Brownsville Matamoros Tijuana San Diego El Paso/Cd.Juarez

29. Loose governance Innovation Adaptability Learning capacity A new space for health Characteristic of settings networks

30. Pan American Health Organization Regional Office for the World Health Organization Thank you very much Celebrating 100 Years of Health