Taking action is critical to assuring conditions for health for all. Consistent with the action plan, this may involve advocating for or implementing programs and policies that address priority issues.
Key Questions to Consider
- Have we identified and prepared the workforce to implement the changes (in programs, policies, practices)?
- How do we support or create mechanisms for communication and dialogue that allow diverse people to be engaged in the action?
- Have we assured the resources (eg., time, money) to implement these changes?
- Are our actions being implemented as planned? Are they strengthening community assets?
- In light of changing circumstances, are we making needed updates to the action plan?
- How do we assure accountability for the actions taken or planned?
How do we do this? Here are some recommended activities to Act
- Create and use the political will to take the actions needed to meet the mission and objectives.
- Mobilize and support collaborative action and advocacy across sectors to bring about programs and policies to address priority issues (e.g., road safety, water and sanitation, emergency response, maternal and child mortality, etc.)
- Mobilize the resources necessary to support action (e.g., update the budget lines, ensure new and continuous funding, seek in-kind donations, etc.)
- Consider that the following themes are present in all activities: human rights, gender, intercultural relevance, and inclusion
- Consider whether the actions are designed to address inequities, i.e., decrease exposures to health damaging factors, reduce vulnerabilities of populations, and assure access.
- Consider an approach that generates health (health promoting) rather than one that prevents illness (risk reduction)
- Provide technical support to implement interventions (and adapt as needed) to fit the local culture, context, and available resources
- Build capacity and strengthen human resources for this work, including by enhancing access to technology and assuring training of the workforce in all relevant sectors
The Zero Hunger Pact
The Zero Hunger Pact was created in 2012 by Guatemalan President Otto Perez Molina as part of his “National Agenda for Change”. The program was designed to reduce malnutrition, provide education, and create better opportunities for families, especially those living in poverty.
The Pact’s programs and policies placed equity at the core and benefited from political commitment from the highest level of government. It galvanized action from a broad, multi-sectoral group including the Guatemalan government, the Scaling Up Nutrition (SUN) Movement, World Food Programme, World Vision International, the Inter-American Development Bank, and other UN and civil society organizations. In just 12 months after its creation, the Zero Hunger Plan achieved positive results in 166 municipalities, particularly for children under five.
In one locality, the municipal government of Tajumulco formally adopted the healthy municipalities strategy. It designed and implemented a local health plan to address social determinants of health in alignment with the Zero Hunger Pact. Tajumulco has set up a Municipal Commission on Health, Food Security and Nutrition (COMUSSAN) to coordinate implementation of the Zero Hunger Pact. The City Council, represented by the council member for health, chairs the Commission and provides legal backing for its activities.
The implementation of the Zero Hunger Pact in the municipality of Tajamulco is a good example of how a national policy can be adopted and implemented locally through cooperation among different sectors.
- Pan American Health Organization. Health in All Policies: Summary of experiences from the Americas. The 8th Global Conference on Health Promotion; 2013 Jun 10-14; Helsinki (Finland). Washington, DC: PAHO; 2013
- Pan American Health Organization (PAHO). Health in All Policies in the Americas: The Zero Hunger Pact and its Implementation in Tajumulco [Internet]; 2016. Available from: http://saludentodaslaspoliticas.org/en/experiencia-amp.php?id=3
Red Intersectorial Guarulhos Ciudad que Protege (Taking Action to Protect Children)
The “Red Intersectorial Guarulhos Ciudad que Protégé” (RIGCP) was created in 2010 to strengthen action to defend and promote the rights of children and adolescents and to prevent violence in Guarulhos. The project used a comprehensive and systematic approach to increase problem-solving capacities in the implementation of public policies of the Municipality of Guarulhos. The initiative was launched in schools. Partners included the Municipal Secretariats of education, health and social assistance; the Municipal Council for the Rights of Children and Adolescents; the Violence Prevention Committee; the Coordinator of the Woman; and the Secretariat of Public Security.
The RIGCP’s objectives were to improve the flow of services for cases of violence against children and adolescents, strengthen the Network for the Protection of Children and Adolescents’ Human Rights, and implement Municipal decrees protecting children and adolescents in public policies and educational curricula. Related actions included:
- Capacity-building and joint dialogue on how to increase the flow and improve the effectiveness of problem-solving actions in cases of violence
- Producing materials and documents to guide actions from different areas of public policy
- Implementing violence-themed awareness campaigns and seminars, and developing specific violence prevention projects in the territories
An intersectoral managing committee within the Municipality was put in place in 2015, allowing for stability and sustainability of the coordination of activities, even when policies change.
- Secretaria Municipal da Educação de Guarulhos. 2016. A Trajetoria de Articulação da Rede Intersetorial ´Guarulhos Cidade que Protege´ no Enfrentamento às Violencias contra Crianças e Adolescentes.
- Grupo Gestor Intersetorial. 2012. Carta de Principios da Rede Intersetorial ´Guarulhos Cidade que Protege.
Movilidad Sustentable (Taking Action for Sustainable Transportation)
CIUDAD DE MEXICO, MEXICO
The Estrategia de Movilidad en Bicicleta / Bicycle Transportation Strategy (EMB) was established in Mexico D.F’s Secretariat of Environment in 2009. It seeks to promote bicycling as a sustainable means of transportation. Key activities include creating networks of bicycle lanes, integrating biking in the networks of public transportation, rendering bicycles accessible to people, and promoting a culture of bicycle use.
Implementation featured four main projects: (1) Muevete en Bici (Move on a Bike), an initiative where the local government closed some of the main avenues to encourage locals to use the roads on bicycle; (2) BiciEscuela (BikeSchool), a capacity-building program on road safety to teach about the rights and responsibilities of those using bicycle lanes, with tailored iterations for working-age adults (18-45 years old), students, and public servants; (3) ECOBICI, a bike-sharing program for locals to borrow a bike from a station and drop it off at another station; and (4) Equipment and infrastructure, to increase and improve the uni-directional bike lanes, exclusive lanes for buses and bicycles, and areas of slow traffic as well as make available enough bicycle parking spaces as possible.
This strategy reflects a city model of common good that promotes harmonious living in the city, recuperating public spaces, and improving people’s health.
- Ciudad de México, Secretaría del Medio Ambiente. Movilidad Sustentable [Internet]; 2017. Available from: http://www.sedema.cdmx.gob.mx/programas/programa/movilidad-sustentable
- Gobierno del Distrito Federal Secretaría del Medio Ambiente. Estrategia de Movilidad en Bicicleta: Estrategia de Movilidad en Bicicleta en la Ciudad de México. Available from: http://data.sedema.cdmx.gob.mx/sedema/images/archivos/movilidad-sustentable/movilidad-en-bicicleta/emb/estrategia-movilidad.pdf
- Gobierno del Distrito Federal Secretaría del Medio Ambiente. Visión integral: Estrategia de Movilidad en Bicicleta en la Ciudad de México. Available from: http://www.sedema.cdmx.gob.mx/storage/app/media/programas/movilidad-sustentable/movilidad-bicicleta/vision-integral.pdf
Resources to Help You Take Action
Resources from the World Health Organization/Pan American Health Organization:
- A conceptual framework for action on the social determinants of health
- Implementation Tools: Package of Essential Non-communicable (PEN) disease interventions for primary health care in low-resource settings
- Comprehensive implementation plan on maternal, infant and young child nutrition
- Mental health action plan 2013 – 2020
- WHO Humanitarian response plans 2015
Resources from Partners/Countries:
- Experiencias Municipales 2012, Programa Nacional de Municipios y Comunidades saludables Argentina (Spanish)
Resources from the Community Tool Box (CTB):
- Developing an Intervention
- Enhancing Cultural Competence
- Advocating for Change
- Influencing Policy Development
CTB Troubleshooting Guide(s) for Solving Common Problems:
- There is not enough action to promote change
- We are facing opposition or conflict
- We need to assure better conditions for implementation
Other Related CTB Readings:
- Chapter 7: Encouraging Involvement in Community Work
- Chapter 6: Promoting Interest in Community Issues
- Chapter 30: Principles of Advocacy
- Chapter 34: Media Advocacy
- Chapter 32: Providing Encouragement and Education
- Chapter 19: Choosing and Adapting Community Interventions
- Chapter 12: Providing Training and Technical Assistance
- Chapter 27: Cultural Competence in a Multicultural World
- Chapter 33: Conducting a Direct Action Campaign
- Chapter 35: Responding to Counterattack
- Chapter 17, Section 5. Addressing Social Determinants of Health and Development