The Participatory Evaluation of Healthy Municipalities, Cities and Communities Initiatives in the Americas

Abstract

Activities addressing the basic determinants of health have increased significantly, yet social and economic inequities continue to erode health conditions for many population groups. This is the reason why health promotion must continue to focus on bridging gaps among and within countries. Creating a healthy and supportive setting, also known as the settings approach, continues to be the most used health promotion strategy. Proven, cost-effective health promotion strategies can protect and improve the health of all persons. Determinants of poverty and equity, and their influence on health can be addressed through creating sustainable public policies and laws, developing supportive environments, building public-private partnerships, strengthening networks, mobilizing the media and other means of communication, and promoting an active role of municipal and local governments in health promotion and development. This article describes experiences and summarizes the main lessons learned from the application of a participatory evaluation methodology to three Healthy Municipalities, Cities and Communities initiatives in Brazil and Peru. The Healthy Municipalities and Communities (HMC) Movement in the Americas The Pan American Health Organization (PAHO) defines health promotion based on the Ottawa Charter (1986), which states that health is “the process of enabling and empowering people to take control over and improve the determinants of health.” Health is promoted in the social context of people’s daily lives, and is supported by public policies that affect social conditions and life styles, and these in turn give shape to healthy behaviors. PAHO developed and introduced the Healthy Municipalities, Cities and Communities (HMC) strategy in the 1990s to improve and promote local health and development. This strategy is being actively implemented in 18 of the 35 countries and three territories of the Americas.