A Bet for the Reduction of Health Inequities in Accordance with the Conditions of the Latin American Region

  • Ligia Malagón de Salazar


The present chapter has a threefold objective: (1) to highlight the potential of the Latin American region to contribute in the reduction of health inequities; (2) to show, using concrete facts, that this goal is not only possible but desirable; (3) to present a strategy that combines three public health functions according to the political, social, and structural characteristics of the territory where interventions are carried out. Evaluation research is a key element for an effective implementation of this strategy; it integrates all the components of the strategy and the whole process to reduce health inequities. To this end, theoretical and practical elements are proposed to extend the scope of the evaluation, so that it becomes a technical instrument for political and social purposes. In a globalized world, low- and middle-income countries should strengthen their capacity to actively participate and negotiate their agendas, starting from the local territorial level, to increase their capacity to negotiate with the other levels. The chapter explores the type of evaluation required, the type of questions and indicators to understand and judge advances, and methodological approaches that allow the evaluation to fulfill its central objective: to provide relevant and credible information to support the decision-making process as well as to serve as an instrument for permanent learning and strengthening of capacity.


Evaluation research Capacity building Territory 


  1. Almeida Filho N, Silva Paim J (1999) La crisis de la salud pública y el movimiento de la salud colectiva en Latinoamérica. Cuadernos Médico Sociales 75:5–30Google Scholar
  2. Bamberger M, Rugh J, Mabry L (2012) Real world evaluation. Sage, Thousand OaksGoogle Scholar
  3. Baum F, Lawless A, Williams C (2015) Health in all policies from international ideas to local implementation: policies, systems and organisation. In: Clavier C, De Leeuw E (eds) Health promotion and the policy process. Oxford University Press, Oxford, pp 188–217CrossRefGoogle Scholar
  4. Bauman F, Lawless A, Williams C (2013) Health in all policies from international ideas to localGoogle Scholar
  5. Burke Johnson R, Onwuegbuzie AJ (2004) Mixed methods research: a research paradigm whose time has come. Educ Res 33(7):14–26CrossRefGoogle Scholar
  6. Clark NM, Mcleroy KR (1998) Reviewing the evidence for health promotion in the United States. In: Kenneth DJ, Macdonald G (eds) Quality, evidence and effectiveness in health promotion. Routledge, New YorkGoogle Scholar
  7. Clarvis MH, Allan A (2013) Adaptive capacity in a Chilean context: a questionable model for Latin America. Environ Sci Pol 43:1–13Google Scholar
  8. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M (2008) Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 337:a1655CrossRefGoogle Scholar
  9. Creswell JW (2013) Telling a complete story with qualitative and mixed methods research.
  10. Creswell JW, Klassen AC, Clark P, Vicki L, Smith C, Katherine (2010) Best practices for mixed methods research in the health sciences. Bethesda, Office of Behavioral and Social Sciences Research (OBSSR)Google Scholar
  11. Chaves L, Alves C, Alba da Cunha A, Jamilly S, Larissa B, Dantas de Araújo P, Parada Costa Silva T (2014) Curso “Participação popular, movimentos sociais edireito à saúde”: uma experiência de educação popular em Saúde na Bahia a partir do MobilizaSUS. Interface 18(2):1507–1512CrossRefGoogle Scholar
  12. Durlak JA (1998) Why program implementation is important. J Prev Intervent Comm 17:5–18CrossRefGoogle Scholar
  13. Díez E, Aviñó D, Paredes-Carbonell JJ, Segura J, Suárez Ó, Gerez MD, Pérez A, Daban F, Camprubí L (2016) Una buena inversión: la promoción de la salud en las ciudades y en los barrios. Gac Sanit 30(S1):74–80CrossRefGoogle Scholar
  14. De Salazar L (2009) Efectividad en promoción de la salud y salud pública: Reflexiones sobre la práctica en América Latina y propuestas de cambio. Programa Editorial Universidad del Valle, CaliGoogle Scholar
  15. De Salazar L (2011) Reflexiones y posiciones alrededor de la evaluación de intervenciones complejas. Programa Editorial Universidad del Valle, CaliGoogle Scholar
  16. De Salazar L (2012) Abordaje de la equidad en intervenciones en Promoción de la Salud en los países de la UNASUR. CEDETES, CaliGoogle Scholar
  17. De Salazar L, Pineda BL (2015a) La Gestión Intersectorial para el Abordaje de las Inequidades en Salud desde el Ente Territorial Municipal: Capacidades, Limitaciones y Desafíos. FUNDESALUD, CaliGoogle Scholar
  18. De Salazar L, Pineda BL (2015b) Investigación evaluativa: instrumento de política social. FUNDESALUD, CaliGoogle Scholar
  19. De Salazar L (2016) Intersectoral action for health—experiences from small countries in the WHO European region. World Health Organization, CopenhagenGoogle Scholar
  20. Fetterman D (2005) A window into the heart and soul of empowerment evaluation: looking through the lens of empowerment evaluation principles. In: Fetterman DM, Wandersman A (eds) The principles of empowerment evaluation. Guilford, New YorkGoogle Scholar
  21. Galeano C, Magaña A, Gómez S (2012) Guía para la Sistematización de Intervenciones en Salud Pública y Promoción de la Salud. CEDETES, Universidad del Valle—Ministerio de Salud y Protección Social, CaliGoogle Scholar
  22. Gantner L, Christine O (2012) Evaluation of public health professionals’ capacity to implement environmental changes supportive of healthy weight. Eval Program Plann 35(3):407–416CrossRefGoogle Scholar
  23. García-Muiña FE, Navas-López JE (2007) Explaining and measuring success in new business: the effect of technological capabilities on firm results. Technovation 27(1–2):30–46CrossRefGoogle Scholar
  24. García Linera A (2008) La potencia pleveya. Acción colectiva e identidades indígenas, obreras y populares en Bolivia. Prometeo/CLACSO, Buenos AiresGoogle Scholar
  25. Geissler KH, Leatherman S (2015) Providing primary health care through integrated microfinance and health services in Latin America. Soc Sci Med 132:30–37CrossRefGoogle Scholar
  26. Green G, De Leeuw E, Ritsatakis A, Webster P, Dyakova M, Palmer N, Spanswick L (2014) Health and equity. In: De Leeuw E, Tsouros AD, Dyakova M, Green G (eds) Healthy cities. Promoting health and equity—evidence for local policy and practice. World Health Organization, CopenhagenGoogle Scholar
  27. Hartz, Zulmira María de Araújo (1997) Avaliação em Saúde: dos modelos conceituais à prática na análise da im plantação de programs. In: Hartz, Zulmira María de Araújo (Edit.) Fiocruz. Rio de JaneiroGoogle Scholar
  28. Hawe P, Noort M, King L, Jordens C (1997) Multiplying health gains: the critical role of capacity-building within health promotion programs. Health Policy 39(1):29–42CrossRefGoogle Scholar
  29. Hawe P, Shiell A, Riley T (2004) Complex interventions: how «out of control» can a randomized controlled trial be? Br Med J 328:1561–1563CrossRefGoogle Scholar
  30. Hesse-Biber S (2015) Mixed methods research: the “thing-ness” problem. Qual Health Res 25(6):775–788CrossRefGoogle Scholar
  31. Heward S, Hutchins C, Keleher H (2007) Organizational change—key to capacity building and effective health promotion. Health Promot Int 22:170–178CrossRefGoogle Scholar
  32. Holling CS, Gunderson LH (2002) Resilience and adaptive cycles. In: Gunderson LH, Holling CS (eds) Panarchy: understanding transformations in human and natural systems. Island Press, Washington, DCGoogle Scholar
  33. Ibarra P, Grau E (2000) Anuario de Movimientos sociales. Una mirada sobre la red. Icaria y Getiko FundazioaGoogle Scholar
  34. Iriart C, Waitzkin H, Breilh J, Estrada A, Merhy EE (2002) Medicina social latinoamericana: aportes y desafíos. Rev Panam Salud Publica 12(2):128–136CrossRefGoogle Scholar
  35. Israel BA, Cummings KM, Dignan MB, Heaney CA, Perales DP, Simons-Morton BG et al (1995) Evaluation of health education programs: Current assessment and future directions. Health Educ Q 22(2):364–389CrossRefGoogle Scholar
  36. Kazi MF (2003) Realist evaluation in practice. Health and social work. Sage, Thousand OaksCrossRefGoogle Scholar
  37. Kay JJ, Boyle M, Regier HA, Francis G (1999) An ecosystem approach for sustainability: addressing the challenge of complexity. Futures 31:721–742CrossRefGoogle Scholar
  38. Khaiklenga, Piyapong; Wongwanichb, Suwimon; Sriklaubb, Kanit; Ajpruc, Haruthai; y Smuntavekind, Sudpranorm. (2015). A training module for evaluation capacity building of a health support organisation in Thailand. Procedia Soc Behav Sci, 171, 1395–1399Google Scholar
  39. Kliksberg B (2011) Estrategias y metodologías para promover la participación social en la definición e implantación de políticas públicas de combate a las inequidades en salud. In: Conferencia mundial sobre determinantes sociales de la salud, Rio de Janeiro, BrazilGoogle Scholar
  40. Krishnaveni R, Sujatha R (2013) Institutional capacity building: a systematic approach. SCMS J Ind Manage 10(4)Google Scholar
  41. Lavis J, Moynihan R, Oxman A, Paulsen E (2008) Evidence-informed health policy 4—case descriptions of organizations that support the use of research evidence. Implement Sci 3:56CrossRefGoogle Scholar
  42. Liberato SC, Brimblecombe J, Ritchie J, Ferguson M, Coveney J (2011) Measuring capacity building in communities: a review of the literature. BMC Public Health 2011;11:850. doi:
  43. Llambías Wolff J (2003) Los desafíos inconclusos de la salud y las reflexiones para el futuro en un mundo globalizado. Revista Cubana Salud Pública 29(3):236–245Google Scholar
  44. Madjar I, Walton JA (2001) What is problematic about evidence? In: Morse JM, Swanson JM, Kuzel AJ (eds) The nature of qualitative evidence. Sage, Thousand OaksGoogle Scholar
  45. Mahoney M, Simpson S, Harris E, Aldrich R, Stewart WJ (2004) Equity focused health impact assessment framework. The Australasian Collaboration for Health Equity Impact Assessment (ACHEIA). ACHEIA, SydneyGoogle Scholar
  46. Manríquez L, Luis J (2006) Globalización, salud y seguridad. Coordenadas de un “nuevo tema” de la agenda internacional. CIDOB d’Afers Internacionals 72:143–159Google Scholar
  47. Mark M, Henry G, Julnes G (2000) Evaluation: an integrated framework for understanding, guiding, and improving policies and programs. Jossey-Bass, San FranciscoGoogle Scholar
  48. Mayoh J, Onwuegbuzie AJ (2013) Surveying the landscape of mixed methods phenomenological research. Int J Multiple Res Approaches 8:2–14CrossRefGoogle Scholar
  49. McLean S, Feather J, Jones B, David (2005) Building health promotion capacity: action for learning, learning from action. UBC Press, VancouverGoogle Scholar
  50. McQueen D, Anderson L (2001) What counts as evidence: issues and debates. In: Rootman I, Goodstadt M, Hyndman B, McQueen DV, Potvin L, Springett J, Ziglio E (eds) Evaluation in health promotion. Principles and perspectives, European Series, vol 92. WHO, Copenhagen, pp 63–79Google Scholar
  51. McQueen DV, Wismar M, Lin V, Jones CM (2012) Introducción: Salud en Todas las Políticas, los determinantes sociales de la salud y la gobernanza. In: McQueen DV, Wismar M, Lin V, Jones CM, Davies M (eds) Gobernanza Intersectorial para la Salud en Todas las Políticas. World Health Organization, GenevaGoogle Scholar
  52. Mercado-Martínez FJ (2002) Investigación cualitativa en América Latina: Perspectivas críticas en salud. Int J Qual Methods 1(1):1–15CrossRefGoogle Scholar
  53. Mejía LM (2013) Los Determinantes Sociales de la Salud: base teórica de la salud pública. Facultad Nacional de Salud Pública 31(1):S28–S36Google Scholar
  54. Menéndez EL (1995) Participación social en salud como realidad técnica y como imaginario social. Dimensión Antropológica 5:7–37Google Scholar
  55. Morgan D (2014) Pragmatism as a paradigm for social research. Qual Inq 20(8):1045–1053CrossRefGoogle Scholar
  56. National Collaborating Center for Determinants of Health (2012) Assessing the impact and effectiveness of intersectoral action on the social determinants of health and health equity: an expedited systematic review. National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Antigonish, NSGoogle Scholar
  57. Novo M (2006) El desarrollo sostenible. Su dimensión ambiental y educativa. UNESCO-Pearson Educación S.A. Madrid, EspañaGoogle Scholar
  58. Ottersen OP, Dasgupta J, Blouin C, Buss P, Chongsuvivatwong V, Frenk J, Fukuda-Parr S, Gawanas BP, Giacaman R, Gyapong J, Leaning J, Marmot M, McNeill D, Mongella GI, Moyo N, Møgedal S, Ntsaluba A, Ooms G, Bjertness E, Lie AL, Moon S, Roalkvam S, Sandberg KI, Scheel IB (2014) The political origins of health inequity: prospects for change. Lancet 383(9917):630–667CrossRefGoogle Scholar
  59. PAHO (2007) Capacidades en salud pública en América Latina y el Caribe: evaluación y fortalecimiento, Pan American Health Organization, Washington, DCGoogle Scholar
  60. Pawson R (2001) Evidence and policy and naming and shaming. ESRC UK Centre for Evidence-Based Policy and PracticeGoogle Scholar
  61. Pawson R (2002) Evidence-based policy: the promise of realist synthesis. Evaluation 8:340–358CrossRefGoogle Scholar
  62. Pawson R (2003) Nothing as practical as a good theory. Evaluation 9:471–490CrossRefGoogle Scholar
  63. Pont Vidal Josep (1998) La investigación de los movimientos sociales desde la sociología y la ciencia política. Una propuesta de aproximación teórica. Papers 56, 257-272. Universitat Autònoma de Barcelona. Facultat de Ciències Polítiques i SociologíaGoogle Scholar
  64. Potvin L (2007) Evidence in public health and health promotion: a debate; a response under construction; a key aspect in the research agenda (Conferencia). In: Seminario taller Internacional de Evaluación de Efectividad en Salud Pública. Un Enfoque desde los Determinantes Sociales y la Promoción de la Salud, Cali, ColombiaGoogle Scholar
  65. Rantala R, Bortz M, Armada F (2014) Intersectoral action: local governments promoting health. Health Promot Int 29(S1):62–102Google Scholar
  66. Ray LD, Mayan M (2001) Who decides what counts as evidence? In: Morse JM, Swanson JM, Kuzel AJ (eds) The nature of qualitative evidence. Sage, Thousand OaksGoogle Scholar
  67. Reygadas L (2004) Las redes de la desigualdad: Un enfoque multidimensional. Política y Cultura 22:7–25Google Scholar
  68. Rozas Ossandon G, Leiva Benavides E (2005) Intersectorialidad en las políticas orientadas a la superación de la pobreza en chile: una perspectiva desde la psicología comunitaria. Acta Colombiana de Psicología 14(5):5–18Google Scholar
  69. Singh D (2008) How can chronic disease management programmes operate across care settings and providers? World Health Organization, GenevaGoogle Scholar
  70. Smelser NJ (1962) Theory of collective behavior. Free Press, New YorkGoogle Scholar
  71. Spiegel J, Alegret M, Clair V, Pagliccia N, Martínez B, Bonet M, Yassi A (2012) Intersectoral action for health at a municipal level in Cuba. Public Health 57:15–23Google Scholar
  72. Stake RE, Abma TA (2005) Responsive evaluation. In: Mathison S (ed) Encyclopaedia of evaluation. Sage, Beverley HillsGoogle Scholar
  73. Stevens A, Milne R (2004) Health technology assessment in England and Wales. Int J Technol Assess Health Care 20:11–24CrossRefGoogle Scholar
  74. Stolkiner A (2010) Derechos humanos y derecho a la salud en América Latina: la doble faz de una idea potente. Med Soc 5(1):89–95Google Scholar
  75. Tang KC, Ehsani JP, McQueen DV (2003) Evidence based health promotion: recollections, reflections, and reconsiderations. J Epidemiol Commun Health 57:841–843CrossRefGoogle Scholar
  76. Turner R, Killian L (eds) (1957) Collective behavior. Englewood Cliffs, Prentice HallGoogle Scholar
  77. Wandersman A, J S-J, L B, Fetterman D, Keener DC, Melanie L, Pam I, Flaspohler P (2005) In: Fetterman D, Wandersman A (eds) The principles of empowerment evaluation. The Guilford Press, New YorkGoogle Scholar
  78. Williams T, Shepherd DA (2015) Mixed method social network analysis: combining inductive concept development, content analysis, and secondary data for quantitative analysis. Org Res Meth 20(2):268–298CrossRefGoogle Scholar
  79. World Health Organization (2016) Intersectoral action for health—experiences from small countries in the WHO European region. WHO Regional Office for Europe, CopenhagenGoogle Scholar
  80. Zhou L, Geng N, Jiang Z, Wang X (2017) Combining revenue and equity in capacity allocation of imaging facilities. Eur J Oper Res 256:619–628CrossRefGoogle Scholar


  1. Appadurai A (2011) Anjali Appadurai speech to 2011 UN Conference on Climate Change in Durban. [Consultado 20 de abril de 2017]. Disponible en
  2. Schutt R (2015) Why use mixed methods? [Consultado 29 de junio de 2017]

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Foundation for Public Health Development (FUNDESALUD)CaliColombia

Personalised recommendations