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In 2012, Medellin set out to transform itself into a healthy city. It assessed its past, reevaluating the achievements and developments of previous administrations. It studied its present, joining efforts with the University of Antioquia, assessing the challenges and possibilities of a healthy model for the city. And the city began to build its vision by joining citizens, their organizations and the private sector. These efforts have allowed that in the recent four years the city has invested its resources and efforts to improve its surroundings where people can either gain or lose health by acting on key determinants such as the environment, employment, education, housing and poverty. Since then the Ministry of Health not only runs the programs it is responsible for, it also coordinates and supports all of the health generating structure of the city.
Bolsa Familia is a Brazilian government program that originated from the legislative and executive powers. It serves families in extreme poverty by increasing their human capital and improving their development opportunities through cash transfers and by increasing access to public services and food, among other actions. It assumes an intense inter-sectoral coordination and shows good results in child nutrition, lower fertility rates, improved maternal education and a higher purchasing power.
The Special Act to Regulate Tobacco in Honduras , has been active since 2011. This act regulates the production, distribution , marketing, import, consumption and advertising of tobacco. It was the result of an intense and intersectoral negotiation process to design it, promote it at the legislative level for its adoption as a policy, and subsequent coordination to familiarize citizens with it.
When classes end, the children in Costa Rica go to school stores to buy food. The Ministries of Health and Education saw the daily need for food and drinks as an opportunity to promote healthy eating habits and proposed regulating which products are sold in school stores. In the midst of a national debate led by the food industry, the decree was finally passed. The importance of health was proven to be more important than the economic interests of corporations.
A family living in poverty and vulnerability faces the risk of nurturing its children inadequately. A wide inter-sectoral response led by Health and Education was successful in providing this children in Costa Rica with holistic care as well as nutrition and education services. Working mothers are also given the support they need to succeed. This is an example of inter-sectoral coordination in the presence of a social determinant of health.
After hosting the sub-region first Health in All Policies (HiAP) training, the government of Suriname requested support from PAHO and immediately moved towards implementation of the HiAP approach for addressing the social determinants of health. A dedicated team has worked under the leadership of the Ministry of Health on the sub-region first Quick Assessment of Social Determinants of Health to understand the underlying causes of major health problems and associated health inequities. This participatory and intersectoral process lasting six months has left Suriname organized and motivated, with 8 areas of specific action. These will make sure that the responsibility of the health of the population is not only a matter for the Ministry of health, but shared with other sectors, including eight Ministries working closely with non -governmental and community organizations, the private sector, academia and the entire civil society. The experience started in 2015.