Photo of three women engaging in an outdoor activity.

Creating a healthier city requires engaging people most affected. By making participation easier and more meaningful throughout the entire process, we can assure the involvement of those critical to the success of the effort.

Key Questions to Consider

  • What are the mechanisms for dialogue between institutions and the community to move action forward?
  • What institutions or organizations should be involved in working together on initiatives in this city or municipality?
  • What sectors in addition to health need to be involved, and what might their roles be?
  • Who are other key stakeholders, and what do they care about?
  • Who are the community leaders or those that can connect this work to the community?
  • How can these institutions or organizations and stakeholders be brought together?
  • How can each actor be invited to promote high participation?
  • How can each actor be meaningfully engaged in each phase of the work?
    • Assessment
    • Planning
    • Action
    • Evaluation
    • Communicate & celebrate
  • What would successful engagement of each actor look like, including those most affected, and how will we know we have succeeded?
  • What issues are important to the city/community?

How do we do this? Here are some recommended activities to Engage

  • Establish a process to assure meaningful participation among those most affected and those who can help, including groups experiencing social exclusion and health inequities
  • Make a map of actors to identify who to engage in this work
  • Communicate benefits of taking action together
  • Make participation easier and more rewarding
  • Provide an organizational structure and technical support for engagement in assessment, planning, taking action, and evaluation
  • Put together an intersectoral commission or working group that can meet systemically and that has clear objectives and tasks to move each part of the process of becoming a Healthy City forward
  • Identify a person or a team that will be engaged throughout the work and will be responsible for the evaluation of work done towards becoming a Healthy City (this can be someone internal to the team or external to the team)

Field Notes

Engagement through the Green and Healthy Environments Program (PAVS)

Icon image of Brazil flagSÃO PAULO, BRAZIL


In Sao Paulo, Brazil, The Green and Healthy Environments Program (PAVS, for its Portuguese acronym) was launched by the municipal government of the city of São Paulo, Brazil. It addressed environmental issues, such as clean water and sanitation, as part of health promotion activities. Its broad goal was to improve quality of life in the São Paulo municipality under the Programa Saúde da Família – PSF (Family Health Program).


The PAVS initiative aims to empower and build capacity through active community participation. PAVS strengthens intersectoral policy management at the local level. It provides training and skills-building opportunities to about 7,000 community health and social protection agents. Neighborhood, merchant and entrepreneurs associations participate in the program, along with environmental NGOs. These groups each play an important role in supporting and implementing program evaluations. Overall, the intersectoral and participatory approaches adopted by PAVS helped address health inequalities within the participating communities.


The PAVS effort engaged many different partners. Several national and international entities were involved in its implementation, including the Ministry of Health of Brazil, PAHO/WHO, UNEP, University of São Paulo, FLACSO, FIOCRUZ, the Municipal Secretariats of Environment, Health, Social Assistance, and Development, and twelve partners from the Municipal Health Secretariat that participated in the National Family Health Program (PSF). PAVS’ Board of Directors, which was established in the first phase of the program, includes representatives from several of these entities. Since its creation, the project has been converted into a program under the Municipal Health Secretariat. That said, many of PAVS operations fall outside the purview of the health sector.


The proposal was originally drafted by the Municipal Green and Environment Secretariat (MGES) of the State of São Paulo between 2005 and 2006. Currently, the program is managed and funded primarily by the São Paulo City Council. The Municipal Parliament, the Municipal Secretariats of Health, Environment, Education, and Social Assistance all collaborate within the Family Health Program (PSF). The Secretary of Urban Infrastructure and Services (waste management and other utilities) as well as the sub-prefectures also provide support for the program.



  1. Pan American Health Organization (PAHO). Health in All Policies: Case Studies from the Region of the Americas Washington, D.C: PAHO; 2015. Available from:
  2. 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
  3. Pan American Health Organization (PAHO). Health in All Policies in the Americas: Green and Healthy Environments Program in São Paulo (PAVS) [Internet]; 2016. Available from:


Health Promotion and Engagement Through Community Radio

Icon image of Brazil flagPORTO ALEGRE, BRAZIL


How to reach and engage vulnerable communities experiencing high levels of violence and social exclusion? Porto Alegre, Brazil developed and launched an information exchange through community radio. The radio program, “On the Radio Waves”, develops community radio programming to promote public education and awareness on priority health issues, such as mental health.


Programming reaches vulnerable communities affected by high levels of violence and social exclusion. Speakers have a dialogue with the radio audience on how to empower themselves to achieve a better quality of life and to learn about health promotion and disease prevention. Partners engaged in this effort include the Federal University of Rio Grande do Sul (UFRGS) and the Conceição Hospital Group (GHC).


Partners offer regular training programs to a wide range of stakeholders including practitioners, students, and other community members. The On the Radio Waves program also engages different sectors including the Ministries of Health, Culture, and Education. To ensure success and sustainability of the program, the Ministries of Education and Health and the Municipal Health Secretariat include allocations for this program in their budgets.



  1. 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
  2. Pan American Health Organization (PAHO). Health in All Policies in the Americas: Health Promotion through Community Radio AMORB/FM [Internet]; 2016. Available from:

Resources to Help You Engage

Resources from the World Health Organization/Pan American Health Organization:

Resources from Partners/Countries:

Resources from the Community Tool Box (CTB) (Spanish and English):

CTB Toolkits:

CTB Troubleshooting Guide(s) for Solving Common Problems:

Other Related CTB Readings: