1. Celebrating 100 Years of Health
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. Two starting points of a new dynamic
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

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
Workplace
Homes
Communication
Participation
Continuity
Safe
communities
Community Participation
Involve the community (including women and men of all ages and ethnic groups) in the entire process, from initial assessment of the situation, to actions to identify resources and possible solutions, to implementation, monitoring and evaluation
Identify strategies to mobilize the community effectively while respecting the cultural and social values of each specific population
Communications
Use all forms of communication available in the community (mass media, interpersonal discussions, organized groups and all forms of cultural expression including events, songs, dances, story telling, etc.)
Ensure that messages and information are shared with the community on a continuous basis
Adapt messages to specific target audiences
Promote the messages of the HMC Strategy, utilizing existing positive examples and influential personalities
Capacity-Building
Use multiple channels to offer capacity-building (i.e. courses, internet, meetings, etc.)
Include orientation and skill development for each aspect of HMC development
Monitoring and Evaluation
Cover process, outcome and impact, including quantitative and qualitative indicators
Make it participatory and interactive
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

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
Build public commitment by the mayor and municipal council, local government (key sectors), nongovernmental and private sectors and the community (leaders and representatives of organizations and social groups) to the process of improving the quality of life through the HMC Strategy.
Ensure and continuously strengthen community participation during the planning, implementation, and evaluation phases. The HMC Strategy calls for strong community involvement and action and offers a genuine chance to strengthen and consolidate democratic processes at the regional level, especially through the participation of civil society in making decisions about priorities, activities, and the use of resources.
Develop a strategic plan to overcome obstacles and threats to developing and maintaining a Healthy Municipality or Community (HMC). This plan is based on the need to mobilize internal and external resources, provide adequate support and technical cooperation, and create healthy spaces. The participatory, multi-sectoral development process encourages decentralization and should enhance the ability of local communities to make decisions and control resources.
Build consensus and form partnerships through various networks and projects comprised of a wide range of institutions and organizations, both within the health sector itself and with other sectors. Efforts are made to reach consensus among participants with opposing views. The Strategy strongly supports the inclusion of local-governmental representatives, NGOs and the private sector.
Encourage Leadership and participation of all social sectors including the health sector, as many strategies and activities extend beyond the capacity of the health sector alone. At the same time, reorienting health services to include health promotion and illness prevention is both a major challenge and a fundamental opportunity that should be pursued. Care should be taken to guard against excessive control by the health sector.
Formulate healthy public policies at the local, regional, and national levels. This process enables capacity building of those involved in a more democratic form of governance; it gives people the opportunity to participate in public decision-making that affects them, their families, and their communities.
Conduct ongoing monitoring and evaluation to track and assess progress of the initiative, and to identify the intended and the unintended results. It is critical that information and surveillance systems are strengthened and are used to rethink and revise the activities of the initiative.

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
Initial and Organizational Phase
Conduct a participatory assessment with the community to ascertain the health and quality of life situation of the municipality or community by identifying needs, enabling conditions, obstacles and resources
Create an intersectoral and municipal committee to carry out a consultation with the community and together define a common vision and mission. Also it is important to designate a focal point on the municipal council for the HMC strategy
Develop a proposed action plan through a participatory and intersectoral process -which should include local authorities, community (including women and men of all ages and ethnic groups) and other organizations- that defines objectives, goals, expected results, and targets
Gain approval and assign resources for the plan by the Municipal Council
Present, 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
Planning Phase
Designate members of the intersectoral municipal committee to be part of a working group for activity implementation and monitoring
Develop a detailed work plan based on the community assessment (Initial Phase) 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
Expected Outcome: A Healthy Municipality and Community
Promote local healthy public and institutional policies and intersectoral actions
Develop a policy framework and infrastructure to support and sustain the implementation of the Healthy Municipalities and Communities strategy
Create a range of healthy spaces
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 Kit Promoting 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
Community Participation
Involve the community (including women and men of all ages and ethnic groups) in the entire process, from initial assessment of the situation, to actions to identify resources and possible solutions, to implementation, monitoring and evaluation
Identify strategies to mobilize the community effectively while respecting the cultural and social values of each specific population
Communications
Use all forms of communication available in the community (mass media, interpersonal discussions, organized groups and all forms of cultural expression including events, songs, dances, story telling, etc.)
Ensure that messages and information are shared with the community on a continuous basis
Adapt messages to specific target audiences
Promote the messages of the HMC Strategy, utilizing existing positive examples and influential personalities
Capacity-Building
Use multiple channels to offer capacity-building (i.e. courses, internet, meetings, etc.)
Include orientation and skill development for each aspect of HMC development
Monitoring and Evaluation
Cover process, outcome and impact, including quantitative and qualitative indicators
Make it participatory and interactive

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

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