Strategic Lines of Action
Cuba exemplifies a process of incorporating the focus of health promotion in the national system that was initiated at the time of the Revolution, and adapted to the perspective of the social determinants of health over time. It is a case of inter-sectoral work that has been institutionalized and is reflected in the Constitution, where all relevant actor, including community representatives, are summoned to collaborate on the design, implementation and monitoring of policies and programs.
The experience of Boca de Mao in the Dominican Republic is a local example that shows how the Health In All Policies (HiAP) approach may be present at a smaller scale. It showcases the level of coordination between a strong community organization that presents and manages its demands, and a holistic and coordinated response from various government sectors. The experience focuses its efforts on raising awareness through education and moving towards concrete actions on issues that concern the environment, food safety, health monitoring and nutrition.
In 2013 the Chilean Ministry of Health studied the experiences developed since 1998 with the Communal Plans for Health Promotion. The careful review of the evidence gave rise to the Healthy Municipalities, Cities, and Communities strategy. New focus was put on the municipalities that are leading on the territorial participatory assessments, with strategic plans for the next three years and that are strengthening the ability of its people to understand and act on their context. This allows finding solutions to territorial problems using local resources and capabilities, strengthening intersectorial action and at the national level. The local - community - national dialogue is one of the strengths of the strategy, because the policies, actions, and decisions are not going in different directions, but are in constant dialogue with each other.
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.
A law that seeks a tobacco-free country, was the result of a hard negotiation process that mobilized the health sector in Suriname. From the beginning this sector knew it could not act alone . It is based on a collaborative effort with contributions from different sectors. It included lobbying with political leaders and the private sector, as well as a creating awareness and mobilizing citizens. The law was passed in 2013 with an absolute majority.
In Porto Alegre , Brazil, an example of intersectoral information exchange has been launched through a community radio microphone. The radio program " In the Radio Waves " talks and raises awareness about health and its promotion . Speakers have a dialogue with the audience on how to empower themselves to achieve a better quality of life and to learn about disease prevention. This is a case study of community organization, in collaboration with different institutions.