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Healthy Municipalities and Communities

Mission

The mission of the Healthy Municipalities and Communities Movement is to strengthen the implementation of health promotion activities at the local level, placing health promotion at the highest priority of the political agenda; fostering the involvement of government authorities and the active participation of the community, supporting dialogue, sharing knowledge and experiences and stimulating collaboration among municipalities and countries. The movement seeks to build and strengthen multisectorial partnerships in order to improve the social and health conditions in the spaces where people live, advocating for the formulation of healthy public policy, maintaining healthy environments, and promoting healthy lifestyles.

Concept

A municipality is said to begin the process of promoting health in the geographic space and with the population groups involved, when local organizations, citizens and elected authorities enter into an agreement and implement a plan of action that will continuously improve the social conditions that produce health and well-being for all of the people that live in that space. In essence, a healthy municipality is a process that requires strong political conviction and support together with equally strong community determination, participation and action.

Framework

In the Americas, PAHO (WHO/AMRO), has adopted a participatory development framework . The commitment is between the mayor, local government (all sectors) representatives and the people (community leaders, representatives of community groups and organizations. The following activities were observed to be common in the process of building healthy municipalities in the Region of the Americas:

  1. Aspects in the initial phase of the process:
    • meetings of local government authorities and community leaders to understand the concept of healthy spaces and the settings approach to health promotion, these were many times initiated by the health sector,
    • a public statement and joint declaration of the commitment of local government and community organizations to build a healthy municipality,
    • an organized intersectorial planning committee with representatives from community groups,
    • participatory needs assessment and analysis of problems and needs,
    • building consensus and determining priorities for action.
  2. Steps in the planning phase of the process:
    • participatory training of intersectorial committee and task forces in every sector to understand the concept of healthy, the settings approach to health promotion and participatory methodology (needs assessment, planning, evaluation and health education),
    • developing a plan of action with broad based consensus between local government authorities, representatives of all sectors and of community organizations,
    • developing and presenting specific projects to improve local conditions, health, education, housing, employment, recreation, and psycho-social and physical environments,
    • mobilization of resources (personnel, material and financial) to implement the plan of action,
    • establishing an information system, a directory and a plan to monitor and evaluate the process and results of building a healthy municipality (starting a data base).
  3. Moments in the consolidation phase of the process:
    • implementing activities in the plan of action and specific project chores,
    • establishing health promoting schools, work places, market places hospitals and other healthy environments,
    • implementing communication campaigns and health education programs to create healthy lifestyles and prevent risk behaviors and conditions,
    • systematization and evaluation of experiences, quality of participation and participatory approaches, and of the results of the plan of action: improvement in health conditions and quality of life,
    • sharing knowledge and experiences with other municipalities, cities, towns and communities, establishing local and national networks, creating healthy municipalities project offices, newsletters, workshops, seminars, etc.

The movement faces many challenges as it presents many opportunities to continue strengthening health promotion approaches in the region. Without exception there is a need to continue strengthening community participation, both in the planning and evaluation phases. The networks and projects need to continue to build consensus and alliances with the many institutions and organizations within the health sector and with other sectors.

It is important to continue to be aware of the risks of political party manipulation, and to develop negotiation skills to deal with conflicts that may arise over ideological issues. The movements in all of the countries strongly defend the need to accept local government representatives from all political parties. The movement also needs to continue to be aware of the risks of excessive control from the health sector. Health promotion requires the leadership and full participation of all sectors, many strategies and activities go beyond the capacity of the health sector. The health sector needs to continue embracing health promotion approaches, and needs to build its capacity to implement health promotion activities.

The need to mobilize internal and external resources continues to present many limitations to implementing the plan of action in most countries and to deliver technical cooperation at the regional level. The reorientation of health services is an important challenge and a fundamental opportunity to be pursued in the context of this movement. As local government and community leaders understand the concept of healthy municipalities and health promotion goals and approaches, it is plausible that more resources will be allocated to the major challenges facing public health today.

Without a doubt this movement presents a fundamental opportunity to establish healthy public policies at the regional, national and local levels. The movement is supportive of the decentralization processes, it requires decentralization of decision making processes and strengthens local capacity to make decisions and control the use of resources. The healthy municipalities movement requires strong and determined community participation and action and it provides a concrete opportunity to continue strengthening and consolidating democratic processes in the region. It also contributes to build peoples capacity to participate in "reinventing government" and provides opportunities for people to participate in public choices and in decisions concerning them, their family and their community.

Regional Networking

An important component of the support that PAHO/WHO provides to this movement is developing and strengthening regional networking activities and encouraging sharing of knowledge and experiences between municipalities and countries. Collaboration among countries has been a key aspect in the success of the movement.

In the last year the movement has dramatically increased. All of the countries are involved in implementing the healthy municipalities movement, including the island nations of the Caribbean.

In Boca del Río the countries signed two milestone agreements: 1) to create a Latin American Network of Healthy Municipalities and Communities, and 2) to continue building and strengthening their national networks.

The movement faces many challenges as it presents many opportunities to continue strengthening health promotion approaches in the region. Without exception there is a need to continue strengthening community participation, both in the planning and evaluation phases. The networks and projects need to continue to build consensus and alliances with the many institutions and organizations within the health sector and with other sectors.

It is important to continue to be aware of the risks of political party manipulation, and to develop negotiation skills to deal with conflicts that may arise over ideological issues. The movements in all of the countries strongly defend the need to accept local government representatives from all political parties. The movement also needs to continue to be aware of the risks of excessive control from the health sector. Health promotion requires the leadership and full participation of all sectors, many strategies and activities go beyond the capacity of the health sector. The health sector needs to continue embracing health promotion approaches, and needs to build its capacity to implement health promotion activities.

The need to mobilize internal and external resources continues to present many limitations to implementing the plan of action in most countries and to deliver technical cooperation at the regional level. The reorientation of health services is an important challenge and a fundamental opportunity to be pursued in the context of this movement. As local government and community leaders understand the concept of healthy municipalities and health promotion goals and approaches, it is plausible that more resources will be allocated to the major challenges facing public health today.

Without a doubt this movement presents a fundamental opportunity to establish healthy public policies at the regional, national and local levels. The movement is supportive of the decentralization processes, it requires decentralization of decision making processes and strengthens local capacity to make decisions and control the use of resources. The healthy municipalities movement requires strong and determined community participation and action and it provides a concrete opportunity to continue strengthening and consolidating democratic processes in the region. It also contributes to build people's capacity to participate in "reinventing government" and provides opportunities for people to participate in public choices and in decisions concerning them, their family and their community.

Background

The healthy municipalities and communities movement is a main strategy to strengthen the implementation of health promotion activities in the Region. It integrates a series of actions in the areas of public health, popular education and community development. The involvement of local government and the active participation of the community are essential components of the movement as is the involvement of other sectors in a unified front to promote health. Health promotion stresses a settings approach to help focus community participation and action on the formulation of healthy public policy, the maintenance of healthy environments, the creation of healthy lifestyles and the reorientation of local health services. The settings approach embraces a framework that stresses equity and empowerment as the main tenets to health promotion, which not only considers the problems and needs of the population groups in that particular space but also the organizational structure and behavior of the specific setting. Within the context of local government it emphasizes the social, political and economic dimensions for healthy public policy and human development plans of action.

There are several steps that are similar to all of the reported experiences in building a healthy city and/or community, these include starting, getting organized and taking action. These were observed in the healthy cities projects in Canada and the United States as well as in the European experience. The following are the twenty steps identified to get organized and begin the process: build a local support group, understand the healthy cities idea, get to know the city, find financial support, decide organizational location, prepare a project proposal, appoint a project steering committee, analyze the project environment, define project work, set up a project office, plan long-term strategy, build project capacity, and establish accountability mechanisms.

The healthy municipalities movement in the Americas has similar aspects, but also some fundamental differences. Starting the process requires support and leadership from the mayor of the municipality and from community leaders. They need to understand the concept of health promotion and the settings approach which is basic to start a healthy municipality process. It also requires a strong support group with a vision of what the healthy, municipality would be, and knowing the social, economic, demographic and political context for the dream to become reality.

In the Region of the Americas the healthy municipalities movement was built on a rich history of experiences with many projects and it developed its specific characteristics in a context of increased decentralization and democratic processes. Central government functions and control over decisions and resources have slowly but steadily been decentralized to local government. A strong determination to continue strengthening democracy by and in all of the countries of the region has also been an important factor for the healthy municipalities movement.

Other key issues that have facilitated the growth of this movement have been an increased awareness of the need and importance to promote health and to prevent the risks and problems facing much of the population today. Young and old, in all the stages of the life cycle need to be involved in caring for their health. Promoting health requires innovative public health strategies and bold actions. It needs the involvement and commitment of the health system and services but it goes beyond the scope of their mandates. The increase in chronic diseases and violence in the region have changed the goals and approaches in public health.

The first projects were implemented following the European and Canadian experiences with healthy cities, these were: Managua, Nicaragua; Valdivia, Chile; Cienfuegos, Cuba; Zacatecas, Mexico; Manizales, Colombia; Zamora, Venezuela; San Carlos, Costa Rica; and Curitiba, Brazil.

Most of these projects are still active today. WHO/HQ continues to support the Managua Healthy Cities Project with a particular emphasis in environmental and urban health concerns. The Valdivia Project in Chile continues to focus on preventing chronic diseases, obesity, cardiovascular illness, cancer and accidents. Curitiba in Brazil continues to provide an example of urban engineering, care for the ecology and transportation planning that distinguishes this city from others.


Regional Office for the Americas of the World Health Organization
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Tel.: +1 (202) 974-3000 Fax: +1 (202) 974-3663

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