Elementos esenciales para el desarrollo de una estrategia fuerte de promoción de la salud: oportunidades y desafíos para maximizar el rol de las farmacias comunitarias / Key elements for the development of a strong health promoting strategy: opportunities and challenges to maximize the role of community pharmacies

El 20 y el 21 de septiembre de 2018 tuve la oportunidad de facilitar una conferencia organizada por la Sociedad Española de Farmacia Familiar y Comunitaria (SEFAC) en Lanzarote, España. El título de dicha conferencia fue Salud pública y farmacia comunitaria como promotora de salud. Durante la conferencia en Lanzarote, mi objetivo fue ofrecer un marco de referencia útil para fortalecer el papel de las farmacias comunitarias dentro de una estrategia sólida de promoción de la salud relevante para el contexto de Canarias. En este artículo tocaré y expandiré algunas de las reflexiones que hice en esa conferencia, con un enfoque nacional y global

On September 20 and 21, 2018, I had the opportunity to facilitate a conference organized by the Sociedad Española de Farmacia Familiar y Comunitaria [Spanish Society of Family and Community Pharmacy] (SEFAC) in Lanzarote, Spain. The title of this conference was Public Health and Community Pharmacy as Health Pro-moter. During the conference in Lanzarote, my objective was to offer a reference standard to strengthen the role of community pharmacies within a solid strategy of promoting health relevant to the context of the Canary Islands. In this article I will cover and explore reflections made in this conference, with a national and global focus

Governance for health equity: taking forward the equity values and goals of Health 2020 in the WHO European Region

This report is one of 13 task group reports which underpin the work of the European review of the social determinants of health and the health divide. The study was commissioned by the WHO Regional Office for Europe to inform the development of Health 2020. With its distilled lessons, this publication is of vital importance for the WHO European Region’s 53 Member States and their efforts to implement the equity goals of Health 2020. It provides a situation analysis of why policies and interventions to address social determinants of health and health inequities succeed or fail. It also discusses important features of governance and delivery systems that increase likely success in reducing inequities. A systems checklist for governing for health equity as a whole-of-government approach is put forward. This is intended for further discussion and as a framework to support strengthening how countries govern for health equity in practice, through action on social determinants.

Health promotion and health systems: some unfinished business.

One of the five action domains in the Ottawa Charter was Reorienting Health Services. In this paper, we reflect on why progress in this domain has been somewhat lethargic, particularly compared with some of the other action domains, and why now it is important to renew our commitment to this domain. Reorienting health services has been largely overlooked and opportunities missed, although good exceptions do exist. The occasion of the 25th anniversary of the Ottawa Charter represents an important opportunity for health promotion to: (i) renew its active voice in current policy debate and action and (ii) enhance achievements made to date by improving our efforts to advocate, enable and mediate for the reorientation of health services and systems. We outline six steps to reactivate and invest more in this action domain so as to be in a better position to promote health equitably and sustainably in today's fast changing world. Though our experience is mainly based in the European context, we hope that our reflections will be of some value to countries outside of this region.

Addressing the socioeconomic determinants of adolescent health: experiences from the WHO/HBSC Forum 2007.

Over the past 25 years, the WHO collaborative cross-national Health Behaviour in School-aged Children (HBSC) study has been accumulating evidence that provides insights into how to promote the health and well-being of young people. HBSC has increased understanding of the determinants of young people's health, particularly in relation to the social contexts in which they live, learn and play. The study now spans 43 countries and regions in Europe and North America. HBSC provides intelligence for the development and evaluation of public health policy and practice at national, sub-national and international levels. However, the mere existence of evidence does not automatically change policy nor necessarily improve the lives of young people. Effective mechanisms to ensure use of evidence in policy-making and practice are needed. The WHO/HBSC Forum series is a platform designed to facilitate the translation of evidence into action. Forum processes convene researchers, policy-makers and practitioners from across Europe to analyse data, review policies and interventions, and identify lessons learned to improve the health of adolescents through actions that address the social contexts that influence their health. Each Forum process consists of case studies produced by interdisciplinary teams in countries and regions, cross-country evidence reviews, a European consultation, an outcomes statement within a final publication, and a Web-based knowledge platform. In addition to emphasizing the translation of research into action, the Forum series focuses on increasing know-how to scale up intersectoral policies and interventions; reduce health inequities; and involve young people in the design, implementation and evaluation of policies and interventions. Interviews with selected participants in the 2007 Forum process revealed that national-level impacts of involvement were: brokering new or strengthening existing working relationships among members of case study drafting teams and national delegations to events; feeding into the formulation of national policy or practice design; and enabling the comparison of information systems, policies, interventions, and working methods with other countries and against the evidence base, thus providing encouragement for new and/or validation of existing activities. The WHO/HBSC Forum series is an evolving platform. The methodology for each Forum process incorporates lessons learnt through past Fora - within resource constraints - and is based on the principles of efficiency and effectiveness. Areas requiring further development, identified through the aforementioned interviews and based on the reflections of co-organizers, include identification of means to ensure systematic, appropriate and meaningful youth involvement; maximization of the usefulness of the European consultation; and definition of a budget line and framework for evaluation of the process' impact at country level.

Revitalising the evidence base for public health: an assets model.

Historically, approaches to the promotion of population health have been based on a deficit model. That is, they tend to focus on identifying the problems and needs of populations that require professional resources and high levels of dependence on hospital and welfare services. These deficit models are important and necessary to identify levels of needs and priorities. But they need to be complemented by some other perspectives as they have some drawbacks. Deficit models tend to define communities and individuals in negative terms, disregarding what is positive and works well in particular populations. In contrast 'assets' models tend to accentuate positive capability to identify problems and activate solutions. They focus on promoting salutogenic resources that promote the self esteem and coping abilities of individuals and communities, eventually leading to less dependency on professional services. Much of the evidence available to policy makers to inform decisions about the most effective approaches to promoting health and to tackling health inequities is based on a deficit model and this may disproportionately lead to policies and practices which disempower the populations and communities who are supposed to benefit from them. An assets approach to health and development embraces a 'salutogenic' notion of health creation and in doing so encourages the full participation of local communities in the health development process. The asset model presented here aims to revitalise how policy makers, researchers and practitioners think and act to promote a more resourceful approach to tackling health inequities. The model outlines a systematic approach to asset based public health which can provide scientific evidence and best practice on how to maximise the stock of key assets necessary for promoting health. Redressing the balance between the assets and deficit models for evidence based public health could help us to unlock some of the existing barriers to effective action on health inequities. This re-balancing would help in better understanding the factors that influence health and what can be done about them. It would promote a positive and inclusive approach to action.

Revitalising the evidence base for public health: an assets model

A lo largo de la história, los enfoques de la promoción de la saludde la población tenían su fundamento en un modelo basado en las carencias de dicha población. Es decir, tienden a centrar su acción en detectar los problemas y las necesidades de las poblaciones que requieren recursos profesionales y dependen en gran medida de los hospitales y los servicios sociales. Estos modelos basados en las carencias son importantes y necesarios para detectar las necesidades y prioridades. Pero tienen algunas desvantajas. Como por ejemplo, definir a las comunidades y a las personas en términos negativos, sin tener en cuenta lo positivo y lo que funciona bien en el seno de las mismas. Por el contrario, el modelo basado en los activos tiende a acentuar la capacidad real de detectar los problemas y activar las soluciones, lo cual promueve la autoestima de personas y comunidades, y conlleva a una menor dependencia de los servicios profesionales. Gran parte de la evidencia que sirve a los responsables de las políticas para tomar decisiones con conocimiento de causa respecto de los grandes enfoques más efectivos para promover la salud y para abordar las desigualdades en materia de salud se fundamenta en un modelo basado en las carencias y en consecuencia, llevan a la puesta en marcha políticas y prácticas que, de modo desproporcionado restan autonomía a las poblaciones y comunidades que supuestamente tienen que beneficiarse de ellas. El enfoque de la salu y del desarrollo que se basa en los activos de una comunidad adopta la noción salutogénica de generación de salud y, de este modo, fomenta la plena participación de las comunidades locales en el proceso de desarrollo de la salud. El modelo basado en los activos de presentamos aqui pretende revitalizar el pensamiento y la acción de los responsables de elaborar las políticas, de los investigadores y de los profesionales de la salud para promover un planteamiento más basado en los recursos que en las carencias con vistas a abordar las desigualdades en materia de salud. El modelo contiene un enfoque sistemático de la salud pública basado en los activos que puede ofrecer evidencia científica y mejores prácticas sobre cómo optimizar la reserva de activos esenciales para la promoción...(AU)

Системы здравоохранения против бедности

Системы здравоохранения многое сделали и продолжают делать для решения сложной и трудной проблемы бедности и здоровья. В данной публикации дается описание 12 инициатив, уже предпринятых в 10 государствах - членах ВОЗ (Венгрия, Германия, Италия, Кыргызстан, Польша, Республика Молдова, Российская Федерация, Соединенное Королевство, Франция, Хорватия). В книге приводятся предварительные результаты исследований ВОЗ, посвященных тому, как системы здравоохранения могут помочь уменьшить проблему бедности. В частности, на основе этих результатов делаются три основных вывода: системы здравоохранения способны предпринять эффективные действия для улучшения здоровья бедных слоев населения; в отдельных случаях они могут стать дополнительной трудностью в жизни малоимущих; в этой области отмечается настоятельная потребность в большем объеме знаний, улучшении подготовки кадровых ресурсов и наращивании потенциала. Хочется надеяться, что информация, приведенная в настоящей публикации, внесет весомый вклад в усилия ВОЗ, нацеленные на то, чтобы помочь всем странам Европейского региона улучшить здоровье населения и обеспечить большую справедливость за счет уменьшения проблемы бедности и ее последствий для здоровья населения.

Les systèmes de santé s’attaquent à la pauvreté

Dans le cadre des systèmes de santé on a beaucoup agi – et l’on continue à le faire – pour tenter de répondre à ce problème lancinant qu’est l’incidence de la pauvreté sur la santé. Le présent ouvrage décrit douze expériences menées sur ce plan dans dix États membres de l’OMS – Allemagne, Croatie, Fédération de Russie, France, Hongrie, Italie, Kirghizistan, Pologne, République de Moldova et Royaume-Uni. Il étaye les premiers constats de l’OMS sur la manière dont les systèmes de santé peuvent contribuer à atténuer la pauvreté. Trois conclusions se dégagent : la première est qu’à travers ces systèmes il est possible de prendre des mesures pour améliorer la santé des personnes démunies, la seconde, c’est que ces systèmes peuvent aussi parfois constituer un obstacle supplémentaire et la troisième, c’est que les connaissances, la formation et le développement des capacités sont encore très lacunaires dans ce domaine. Les informations présentées iront, faut-il espérer, dans le sens des efforts déployés par l’OMS pour contribuer à ce que tous les pays d’Europe tendent à faire progresser la santé et l’équité en s’attaquant au problème posé par les incidences de la pauvreté sur la santé.

Gesundheitssysteme stellen sich der Armut

Die Gesundheitssysteme versuchen seit geraumer Zeit, aktiv gegen das komplexe und erschreckende große Problem von Armut und Gesundheit vorzugehen. In diesem Buch werden zwölf bereits durchgeführte Initiativen aus zehn Mitgliedstaaten der WHO, nämlich aus Deutschland, Frankreich, Italien, Kirgisistan, Kroatien, Polen, der Republik Moldau, der Russischen Föderation, aus Ungarn und dem Vereinigten Königreich vorgestellt. Das Buch enthält erste Erkenntnisse der WHO zu der Frage, wie Gesundheitssysteme zur Linderung der Armutsproblematik beitragen können. Die Autoren gelangen zu drei wesentlichen Schlüssen: Gesundheitssysteme können wirksam dazu beitragen, die Gesundheit der Armen zu verbessern. Manchmal können sie sich jedoch für Arme auch als zusätzliches Hindernis erweisen. Mehr Wissen, Schulung und Kompetenz werden dringend benötigt. Mit dem vorliegenden Material hofft die WHO, die Länder der gesamten Europäischen Region der WHO in ihrem Bemühen zu unterstützen, durch die Bekämpfung von Armut und deren Folgen die Gesundheit und gesundheitliche Chancengleichheit ihrer Bevölkerung zu verbessern.

Health systems confront poverty

Health systems have done and are doing much to tackle the complex and daunting problem of poverty and health. This book describes 12 initiatives already undertaken in 10 WHO Member States: Croatia, France, Germany, Hungary, Italy, Kyrgyzstan, Poland, the Republic of Moldova, the Russian Federation and the United Kingdom. It documents WHO’s preliminary findings on how health systems can help to alleviate poverty and reaches three main conclusions: that these systems can take effective action to improve the health of the poor, that they can sometimes represent an additional barrier for the poor and that more knowledge, training and capacity-building in this area are urgently needed. It is hoped that the information presented in this publication will contribute to WHO’s efforts to help countries across the length and breadth of Europe improve health and increase equity by tackling poverty and its effects on health.

Evaluation in health promotion: principles and perspectives

Policy-makers, professionals of all kinds and the general public increasingly recognize social and economic factors as important determinants of health. Because health promotion approaches address these factors, they can play a valuable role in protecting and improving health. At the same time, funding sources demand evidence that initiatives give value for money. Health promotion initiatives need effective evaluation to realize their potential: both to prove their value as investments and to increase their effectiveness in achieving their aims. To help meet this need, the WHO European Working Group on Health Promotion Evaluation examined the current range of qualitative and quantitative evaluation methods to provide guidance to policy-makers and practitioners. This book is the result. It comprises an extensive compilation and discussion of the theory, methodologies and practice of evaluating health promotion initiatives in Europe and the Americas. The book takes three perspectives in examining the issues. It includes a retrospective examination of the evolution of health promotion evaluation. This provides the context for assessing and understanding the current state of evaluations of initiatives addressing settings, policies and systems for promoting health. Finally, the authors and the Working Group make many recommendations for improvement that provide a look into the future. This book shows how a health promotion approach offers a comprehensive framework for planning and implementing interventions that can effectively address today’s major health-related problems.