REDLACPROMSA: Latin American and Caribbean Network of Health Promotion Managers

Abstract

Public policies and decisions made in all sectors and at different levels of government have a significant impact on population health and on health equity. Health inequities persist with a social gradient in Latin America, even though the countries in the region have responded to the social and health protection needs of their populations and made sustained progress in addressing the determinants of health and improving the health of their populations. The need for countries to strengthen their health systems from the perspective of health promotion and action on the socio-environmental determinants of health was inserted into the constitution of the Latin American Network of Latin American and Caribbean Managers of Health Promotion (Red Latinoamericana y del Caribe de Gestores de Promoción de la Salud—REDLACPROMSA) in 2015.

REDLACPROMSA was established as an instance of cooperation, exchange, advocacy, and mutual support among health managers of ministries or departments of health promotion. It aims to make health promotion a key element of public policies by means of technical and political cooperation among Latin American and Caribbean countries in order to achieve equity, welfare, and social development. It aims as well to strengthen the stewardship function of ministries of health to act intra- and intersectorally.

The achievement of REDLACPROMSA objectives entails the commitment to implement the World Health Organization strategy “Health in All Policies,” as well as the strategic line 4 (“Strengthening Intersectoral Coordination to Address Social Determinants of Health”) of the Pan American Health Organization 53/5 resolution, “Strategy for Universal Health Access and Coverage,” of September 2014. The methodological principles informing REDLACPROMSA recognize the value of local experiences and social participation as a basis for achieving sustainable regional development, acknowledge the need to advance regional strategies of political incidence in order to put on governments’ agendas a public policy approach based on equity and socio-environmental determinants of health, retain horizontal cooperation as a new collaboration learning model, and use participatory methods and action–reflection processes for planning, implementing, and evaluating public policies aimed at reducing health inequities.

Appendices

Appendix A

22nd IUHPE World Conference on Health Promotion

May 22–26, 2016, Curitiba, Brazil

PROMOTING HEALTH AND EQUITY

CURITIBA STATEMENT ON HEALTH PROMOTION AND EQUITY

To assure Democracy and Human Rights

in all countries around the world

The Curitiba Declaration embodies a spirit of local and global commitment to democracy, equity, and justice. It promotes social rights and “health for all’ in an inclusive and sustainable world.

This Declaration represents the voice of researchers, practitioners, social movement members and policymakers who participated in the 22nd IUHPE World Conference on Health Promotion , held in Curitiba, Brazil in May 2016. The Curitiba Declaration articulates the recommendations of conference participants and focuses on how strengthening health promotion and improving equity, can improve people’s lives where ever they live, work, play and learn.

We want to send a reminder that equity has been recognized as a pre-requisite for health and a key objective of health promotion for at least the past three decades. As the process for creating the Sustainable Development Goals is completed, we must recognize that the achievement of health equity is not a separate goal. Equity is the goal; continuing inequity in gender, race and ethnicity is a sign of system failure.

Participants of the 22nd IUHPE World Conference on Health Promotion recognize their own role and that of global society in pursuing a common agenda and solidarity bonds that collectively advocate for the prioritization of democracy and human rights as essential conditions for the promotion of health and equity.

All players involved in the international, national and local arena must try to work together to produce common directions that take into consideration their respective roles.

We urge International Organizations to recognize that:

• 1. Austerity causes inequity: Health is a human right and should not be treated as a commodity.

• 2. A social and economic system that accelerates capital accumulation and results in extreme wealth concentration is inconsistent with achieving equity goals.

• 3. Many people live in a threatening and hostile environment; and there is a need to work towards the elimination of work practices of corporations that harm health, damage the environment, and compromise social cohesion.

• 4. They have a role in advocating countries implement and enforce progressive income tax to address health equity and strengthen the role of the State in promoting social policies .

We call for Governments at all levels to:

• 5. Implement policies that promote gender and racial/ethnic equity as a main aim and evaluation measure.

• 6. Recognize that citizen participation in health decisions is a right not a concession.

• 7. Use innovative strategies that strengthen and protect the universal right to health and the well-being of the people of the world at all times and especially during any financial crisis.

• 8. Enrich their understanding of the threats that affect vulnerable and marginalized populations.

• 9. Demonstrate better and more transparent use of politics and power .

We recognise that the Health Sector should:

• 10. Be ready to learn from, not simply to lecture to other sectors.

• 11. Design effective health promotion policies and invest more in the capacity of health promotion systems to implement them.

• 12. Advocate to other sectors to recognize the impact that their policies have on human health and well-being, affecting mainly vulnerable populations .

We advocate that Citizens should be invited to:

• 13. Engage in a critical reflection about their role as active participants in the exercise of citizenship.

• 14. Exert their great transformative potential in mobilizing and pressuring local authorities to put health equity in their agendas.

We encourage Health Professionals and Researchers to:

• 15. Adopt new processes to achieve effective social participation, inclusion, intersectoral action and interdisciplinary approaches.

• 16. Recognize that the practice of health promotion is influenced directly and indirectly by politics and ideologies

• 17. Use evidence as an instrument for positive social change. We need science with compassion and with an intercultural approach.

• 18. Play a key role, through the use of multiple interventions, in generating an enabling environment and conditions that ensure ownership and agency with the people with whom they work.

We further advocate that EVERYONE—International Partners, Governments, Health Sector, Health Professionals, Researchers and Citizens—should recognize:

• 19. Their influence in changing and eliminating all forms of discrimination and exclusion.

• 20. The potential and capacity of health promotion throughout the life course.

• 21. Health Promotion goals will only be fully achieved by incorporating these four basic principles: equity, human rights, peace and participation.

Appendix B

THE SANTIAGO DECLARATION

Mayors Preforum, Road to Shanghai

–Chile, July 25 and 26, 2016–

VISION, STRATEGIC DIRECTIONS, AND ACTION COMMITMENTS FOR THE HEALTHY MUNICIPALITIES NETWORKS IN THE AMERICAS

We, the mayors and senior political representatives of cities, municipalities, towns, and territories, gathered at the Mayors Preforum in Santiago, Chile, convinced of the increasing relevance and the significant contribution the Healthy Municipalities movement can make to the health and well-being of our citizens, confirm our commitment to action that will inspire and guide our work in the years to come.

This Declaration is meant to provide political impetus and legitimacy to strengthen the Healthy Municipalities movement in the Americas, building on our past investments and achievements and better tuning to and connecting with twenty-first century approaches to health, social development and sustainable development.

The Santiago Declaration outlines our rationale, the values and the principles, as well as the renewed strategic objectives and approaches of the Healthy Municipalities movement in our region in the light of emerging priorities, scientific evidence on solutions that work, lessons learnt from our work, and the work of the global Healthy Cities movement to date and the relevant regional and global strategies and plans.

The Declaration is structured around four main sections:

• 1. Health and sustainable development and the key role of local governments

• 2. Healthy Municipalities movement: values, principles, and approaches

• 3. A renewed, reinforced agenda and important themes for the Healthy Municipalities movement in the Americas

• 4. Declaration of Santiago, Chile (Political Statement for the Global Conference on Health Promotion, Shanghai, China, November 2016)

Health and Sustainable Development and the key role of local governments

We recognize that:

• Health is a fundamental human right and every human being is entitled to the enjoyment of the highest attainable standard of health.

• Health is a core value and goes hand in hand with the social, economic, human and sustainable development of our cities, municipalities and territories.

• The health status of our people and that of our communities is profoundly affected by the conditions in which individuals are born, live and work.

• The knowledge and experience of the social, environmental, urban, cultural, commercial and political determinants of health provide the basis for how we should understand and deal with health in our cities, municipalities and territories. The public health challenges of the twenty-first century to be addressed effectively require the full engagement of local (municipal) governments.

• Local (municipal) governments can provide effective leadership and capacity for intersectoral work for health and sustainable development and they can promote and enable community involvement and empowerment. Local authorities are in a better position than the health authorities to enlist the participation of a wide variety of social actors.

• Local governments generally have primary responsibility for planning and/or delivering services critical for influencing the social determinants of health (SDH) (e.g., education, transportation, housing, urban planning) and often they have responsibility for health service delivery and public health.

• Local (municipal) governments have a key and central role to play in the implementation of all the sustainable development goals (SDGs) and in particular address the strong links between SDG 3 (Good Health for All) and SDG 11 (Make Cities and Human Settlements Inclusive, Safe, Resilient and Sustainable).

Examples of Areas Where Action by Local Governments Can Make a Significant Difference

Creating the preconditions for community empowerment and inclusiveness in the face of poverty and social disadvantage; giving children a healthy start in life; preventing and managing chronic diseases at community level; promoting active living; tackling obesity; developing community resilience to deal with emergency situations; creating age-friendly environments and promoting healthy urban design.

• The well-being, health and happiness of our citizens depends on our willingness to give priority to the political choices that address equity and the determinants of health.

• Ultimately health is a political choice that should match our values and aspirations for protecting and constantly improving the health and well-being of all our citizens.

• This means creating supportive social and physical environments and conditions for enabling all people to reach their maximum health and well-being potential.

• In the complex world of multiple tiers of government, numerous sectors and both public and private stakeholders, local governments have the capacity to influence the determinants of health and well-being and inequities. They are well positioned to have such influence through whole-of-local government and health in all policies, regulation, integrated strategies and plans and partnerships across society

Healthy Municipalities movement: values, principles and approaches

We are very conscious of the fact that:

• The aim of the Healthy Municipalities movement is to put health high on the social and political agenda of cities, municipalities and territories by promoting health, equity and sustainable development through innovation and change.

• The Healthy Municipalities movement was created on the recognition of the importance of action at the local and urban level and the key role of local governments.

• The Healthy Municipalities movement is a political, strategic, cross-cutting and intersectoral initiative. “Healthy Cities/Healthy Municipalities” is a strong global movement because of its local political connection.

• Healthy Municipalities represents “a real-world laboratory ” to generate good practices, evidence and knowledge, methods and expertise that can be used to promote health in all cities, municipalities and territories in the region of the Americas.

• Healthy Municipalities is a value-based initiative which offers the opportunity to whole-city governments and societies to promote health and well-being for all, using the very best evidence available and innovative ideas at any time.

• It represents a channel of connecting with the urban public health conditions on the ground across the region of the Americas.

Healthy Municipalities’ Influence on Health, Well-Being and Equity

Regulation. Cities are well positioned to influence land use, building standards and water and sanitation systems and enact and enforce restrictions on tobacco use and occupational health and safety regulations

• Integration. Local governments have the capability of developing and implementing integrated strategies for health promotion.

• Intersectoral partnerships . Cities’ democratic mandate conveys authority and sanctions their power to convene partnerships and encourage contributions from many sectors.

• Citizen engagement . Local governments have everyday contact with citizens and are closest to their concerns and priorities. They present unique opportunities for partnering with the private and not-for-profit sectors, civic society and citizens’ groups.

• Equity focus . Local governments have the capacity to mobilize local resources and to deploy them to create more opportunities for poor and vulnerable population groups and to protect and promote the rights of all urban residents.

The values, principles and approaches of the Healthy Municipalities movement are deeply rooted in the Constitution and key strategies and resolutions of the Pan American Health Organization (PAHO) , the World Health Organization (WHO) headquarters, and other agencies as well as in the best available evidence and experience from practices from our Region and beyond.

In this context, we acknowledge the importance and relevance of the:

• Regional Plan of Action on Health in All Policies

• Rio Political Declaration on Social Determinants of Health (2011) and Resolution WHA65.8 (2012) of the World Health Assembly “Outcome of the World Conference on Social Determinants of Health”

• Health Promotion documents : Cuenca Declaration (1978), Ottawa Charter (1986), Declaration of Santa Fé de Bogotá (1992)

• The Curitiba Declaration and the La Granja Declaration

• Political Declaration of the United Nations High-level Meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases (2011)

• The Zagreb (2008) and Athens (2014) Healthy Cities Declarations of the European Healthy Cities movement

• The framework of the Sustainable Development Goals of the 2030 Agenda for Sustainable Development

We stress that:

Healthy Municipalities is a dynamic concept which should be continuously enriched with new developments and emerging priorities and scientific evidence. This is essential for Healthy Municipalities to maintain its relevance and credibility. The agenda, themes and goals of each phase of the Healthy Municipalities movement in the Americas should therefore reflect global and regional priorities and strategies and issues emerging from the urban (health, social, environmental) conditions in our Region.

We declare our constant commitment:

• To the promotion of action to put health high on the social and political agenda of our cities, municipalities, towns and territories

• To the fundamental values of the Healthy Cities-Healthy Municipalities movement since its inception, namely the right to health and well-being, equity and social justice, gender equality, solidarity and social inclusion, universal coverage and sustainable development

• To the following principles and approaches that should underpin all Healthy Cities-Healthy Municipalities policies , strategies and plans: addressing the determinants of health and root causes of ill-health and inequalities; promoting intersectoral action and partnership-based approaches; promoting health and equity in all local policies; supporting community participation, empowerment and democratic governance; and using the life-course approach.

Community participation is essential for the success of the Healthy Municipalities movement

The Ottawa Charter (1986) defined health promotion as “the process of enabling people to increase control over, and to improve, their health.” Giving a voice to individuals and communities and creating the pre-conditions for empowerment and meaningful engagement are at the core of the Healthy Municipalities approach. More than ever before and in the face of the fast changing social landscapes of cities and towns there is a need to create inclusiveness and social cohesion. Empowered communities will have the knowledge, the skills and the means to participate in decisions that affect their health and well-being and also navigate and access resources that can improve their health and quality of life. There is increasing evidence that socially inclusive and cohesive communities are healthier and happier.

We declare our commitment to the following critical issues:

• To investing in our cities, municipalities, and territories and our people striving to create cities for all our citizens.

• To fully using and integrating in our health development work, twenty-first century evidence-based public health and health promotion approaches and solutions that work.

• To ensuring that our policies and plans are comprehensive, systematic and strategic aiming at delivering best outcomes and maximum impact.

• To integrating health and sustainable development considerations in how we plan, design, maintain, improve and manage our cities, municipalities and territories and neighborhoods and use new technologies.

• To valuing social diversity and investing in building trust and cohesion amongst our communities.

• To employing whole-of-local government and whole-of-society and Health in All policies approaches in our efforts to reaching out to different partners (public and corporate) and civil society.

• To focusing in engaging with other sectors on what they can do for health and what health can do for them identifying win-win, synergistic and co-beneficial outcomes.

• To promoting policy coherence, synergies and better coordination as well as systems enabling joint planning and accountability.

• To investing in creating adequate capacity for steering, managing, and implementing our Healthy Municipalities initiatives and programs.

• To putting in place the resources and mechanisms for systematically assessing the health and the conditions that affect health in our cities, municipalities and territories as well as for monitoring our Health in All policies and reducing health inequality efforts.

• To publishing regularly a city health profile as a basis of identifying priorities and accountability for health in our cities, municipalities and territories.

• To increasing our investments in disease prevention and health promotion applying the social determinants of health (SDH) , equity and economic lens and aiming at creating social and physical environments that are conducive to health and well-being as well as increasing health literacy.

• To promoting awareness about individual responsibility and social responsibility for health through SDH and equity perspective.

• To developing strategies and plans that are framed on population-based and life-course approaches.

• To developing an intersectoral integrated strategic framework and plan for health development in the city with commonly agreed goals.

• To making sure that local Healthy Municipalities plans and activities are aligned and connected with the main city development strategies.

• To developing local and national platforms, networks and fora that promote social dialogue and broad civic engagement.

A renewed, reinforced agenda and important themes for the Healthy Municipalities movement in the Americas

The Health Municipalities approach provides an adaptable and practical framework for delivering Health for All at the local level. It provides an exceptional platform for joint learning and sharing of expertise and experience between cities, municipalities and territories within and between our national networks in the Region.

We endorse the fact that:

• Every city is unique and distinctive and within the frame of the overarching goals and themes of Healthy Municipalities approach , cities, municipalities and territories have the flexibility to identify and give weight to areas that are of particular relevance to local realities.

• A big strength of the Healthy Cities/Healthy Municipalities movement is its diversity.

• Our commitment to Healthy Municipalities will not be wholehearted and comprehensive without being true in our actions to its fundamental values and principles.

• The transformative potential of a Healthy Municipalities strategy for local health promotion/development can only be made alive through joint efforts by the different stakeholders in our cities, municipalities, towns and territories.

• The future prosperity of urban populations depends on our willingness and ability to seize new opportunities to enhance the health and well-being of present and future generations.

We are fully convinced that the time is right to reinforce and expand our Healthy Municipalities movement in the Americas and commit to initiate a new phase of Healthy Municipalities in the Americas.

This phase should be shaped on the basis of six strategic priorities:

• 1. To strengthen the political, strategic and operational capacity of our national networks

• 2. To revisit, update and expand the goals, commitments and action agenda of Healthy Municipalities in our Region

• 3. To agree on a minimum number of common goals that will be shared and pursued by all national networks and member cities, municipalities, towns and territories

• 4. To introduce five-year cycles (phases) in the development of the Healthy Municipalities program in the Americas that will provide the opportunity to regularly renew its action agenda and evaluate the outcomes and lessons learned from each phase

• 5. To establish the International Healthy Municipalities Network of the Americas comprised of our national and local networks, and develop a common strategy with principles, priorities, and standards

• 6. To actively seek to connect with the global Healthy Cities movement and key international networks of cities and municipalities that are concerned with aspects of urban development

Investing in Establishing New and Strengthening Existing National Healthy Municipalities Networks

National networks have a key strategic role in promoting the Healthy Municipalities principles and ideas, supporting their member cities, municipalities, towns and territories, organizing training and learning events as well as working with different ministries and participating in national programs

We recognize that:

• Strengthening leadership and governance for health and well-being is fundamentally crucial, and for this reason we will join our efforts to promote better awareness and dialogue about the principles and added value of Healthy Municipalities; the political determinants and capacity required for change and innovation; and methods for reaching out to other sectors and engaging civil society

We declare our commitment to a comprehensive Healthy Municipalities framework that covers six action domains:

• Promoting local leadership and intersectoral governance for health/working together for the health of our city

• Addressing the needs of people of all ages and vulnerable groups/caring for our people and community and promoting equity

• Creating supportive physical and social environments for healthy living/making the healthy choices, the easy choices and healthy settings

• Promoting healthy physical and built environments/making the city clean, safe, attractive and sustainable

• Strengthening community resilience and health literacy/engaging and empowering our people with knowledge and skills for health and well-being

• Strengthening public health services and community care services/making high-quality services accessible to and for all

Local Leadership for Health and Sustainable Development

Local leadership for health and sustainable development means: having a vision and an understanding of the importance of health in social, economic and sustainable development; becoming an advocate and active implementer of the SDG agenda; having the commitment and conviction to forge new partnerships and alliances; promoting accountability for health and sustainability by statutory and non-statutory local actors; aligning local action with national policies; anticipating and planning for change; and ultimately acting as a guardian, facilitator, catalyst, advocate and defender of the right to the highest level of health for all residents. Effective leadership for health and well-being requires strong political commitment, a vision and strategic approach, supportive institutional arrangements and networking and connecting with others who are working towards similar goals.

We declare our commitment to including in our strategies a minimum set of seven common goals:

• To ensure that the HiAPs and SDG agendas are explicitly and fully integrated in our vision and plans

• To give high priority to community participation and empowerment and community resilience

• To measure and systematically and comprehensively address health inequalities

• To give all our children a healthy start in life with the active involvement of different sectors (such as health, social services, education, housing and planning), families and communities

• To create conditions for healthy and active living for all with emphasis on physical activity, healthy and sustainable nutrition, reduction of obesity and mental stress, controlling the use of alcohol and creating smoke- and drug-free cities.

• To increase health literacy among individuals, communities and institutions

• To invest in healthy environments and healthy urban planning and design, creating safe and clean neighborhoods with access to green areas and space for social interaction and good facilities for all and creating age- and child-friendly settings

The Critical Importance of the Life-Course Approach

Supporting good health and its social determinants throughout the life course leads to increased healthy life expectancy as well as enhanced well-being and enjoyment of life, all of which can yield important economic, societal and individual benefits. Interventions to tackle health inequities and their social determinants can be derived at key stages of the life course: maternal and child health; children and adolescents; healthy adults; and healthy older people.

The Importance of a Good Start in Life for Children

A good start in life establishes the basis for healthy life. Cities investing in high-quality early-year childcare and parenting support services can compensate for the negative effects of social disadvantage on early child development. Promoting physical, cognitive, social and emotional development is crucial for all children from the earliest years. Children born into disadvantaged home and family circumstances have a higher risk of poor growth and development.

We finally declare our commitment to:

• Increasing our capacity for effective leadership and intersectoral action through whole-of-government, whole-of-society and HiAP approaches

• Working together as city leaders and as national networks promoting solidarity, sharing experiences and shaping our future visions and strategies

• Generating policy and practice expertise, good evidence, knowledge and methods that can be used to promote health in all cities, municipalities, towns and territories in the Americas Region

• Establishing working links between cities, municipalities and territories and networks of local authorities in the Americas and partnerships with agencies concerned with urban issues

• Increasing the accessibility of the Healthy Municipalities movement in the Americas to all member states in the Region

Declaration of Santiago, Chile

This is our moment!

We, the mayors and city managers of Chile, Ecuador, Peru, Guatemala, Cuba, Brazil, Argentina, Mexico, Haiti, Colombia, Guyana, and Paraguay, present at the Mayors Preforum of the Americas, Road to Shanghai 2016, held July 25–26, 2016, in Santiago, Chile, hereby declare that:

The Global Conference on Health Promotion, to be held in Shanghai, China, in November 2016, offers a unique opportunity to strengthen political commitment to health promotion and the Healthy Cities, Municipalities, Towns, and Territories Movement worldwide.

This is our moment to promote policies and action to address health determinants, human rights, and inequities through health in all policies and intersectoral approaches, within the framework of Sustainable Development Goals.

As local leaders, we are convinced that we have the power to make a real difference in the health and quality of life of the citizens of our territories.

We are determined to improve the development and performance of local and national healthy cities networks.

We are convinced that national policies must recognize the importance of the role of municipalities in health development and actively promote healthy cities networks.

It is our conviction that working together, we can create synergies and platforms for sharing our local experiences and innovations. We have therefore decided to create an International Network of the Americas and develop a common strategy with principles, priorities, and standards.

We call on the international community and international agencies, such as the Pan American Health Organization (PAHO/WHO), to join us in this effort and assume this commitment.

In witness whereof, we, the participating mayors and city managers of the Americas, sign the Declaration of Santiago in La Granja Municipality, Santiago, Chile, on 26 July 2016.