Collaboration between Public Health and Schools: An Example of an Integrated Community Social Care Model.

Introduction: There is a need to improve public health interventions to promote youth social and emotional development in close collaboration with schools, families and local communities. A close intersectoral collaboration between the regional public health, schools and school boards was established to co-construct and implement "Positive Intervention (PI)" in the Eastern Townships region (Quebec, Canada). This paper describes its implementation according to the "Integrated Community Care (ICC)" framework. Description: PI is a collaborative and personalized intervention leaning toward an integrated community social care model. In fact, PI relies on the close proximity between Public Health and their educational counterpart as well as their individual temporality. However, PI offered mainly social services and its relationships with Primary Care services was not yet a priority. Discussion: The results show that it is possible to develop and implement an intervention promoting positive mental health in children, with and for local organisations. The level of integration between schools and Public Health services achieved after only 6 months of implementation is encouraging. Conclusion: More research is needed to thoroughly document the implementation, social validity, and effects of such an intervention by taking in the point of view of all stakeholders.

Introduction: Il est nécessaire d'améliorer les interventions de santé publique pour promouvoir le développement social et émotionnel des jeunes en étroite collaboration avec les écoles, les familles et les communautés locales. Une telle collaboration intersectorielle entre la santé publique régionale, les écoles et les commissions scolaires a été mise en place pour coconstruire et mettre en œuvre l'Intervention positive (IP) en Estrie (Québec, Canada). Cet article décrit sa mise en œuvre initiale selon le cadre conceptuel des soins de santé et services sociaux intégrés en proximité des communautés. Description: L'IP est une intervention collaborative et personnalisée qui s'inscrit dans un modèle de services sociaux intégrés en proximité des communautés. En fait, l'IP s'appuie sur une forte proximité entre les services de santé publique et les milieux scolaires, ainsi qu'un ajustement à la temporalité des partenaires. Cependant, l'IP offre principalement des services sociaux et ses relations avec les services de soins primaires n'étaient pas encore une priorité. Discussion: Les résultats montrent qu'il est possible de développer et de mettre en œuvre une intervention de promotion de la santé mentale positive chez les enfants, avec et pour les organisations locales. Le niveau d'intégration entre les écoles et les services de santé publique atteint après seulement six mois de mise en œuvre est encourageant. Conclusion: Des recherches supplémentaires sont nécessaires pour documenter de manière approfondie la mise en œuvre, la validité sociale et les effets d'une telle intervention en prenant en compte le point de vue de toutes les parties prenantes.

Saúde e saneamento: uma avaliação das políticas públicas de prevenção, controle e contingência das arboviroses no Brasil / Health and sanitation: an evaluation of public policies for the prevention, control, and contingency of arboviruses in Brazil

Resumo As arboviroses, sobretudo as transmitidas pelo mosquito Aedes aegypti, têm-se constituído em grave problema de saúde pública no Brasil. Com o intuito de analisar como o saneamento básico é abordado em instrumentos norteadores das políticas públicas de controle das arboviroses no país, foi realizada uma análise de conteúdo em oito documentos governamentais de referência. Como resultados, foi possível identificar que aspectos relacionados à comunicação e mobilização social, controle vetorial e gestão são os temas mais abordados nos documentos analisados. Já as componentes do saneamento básico, destacando-se o manejo e a drenagem das águas pluviais e o esgotamento sanitário não são abordados nos instrumentos. A intersetorialidade é mencionada, no entanto, não existem proposições específicas que apontem e assegurem sua implementação. As Diretrizes Nacionais para a Prevenção e Controle de Epidemias de Dengue, do Ministério da Saúde, constitui-se no documento mais completo sobre o assunto. Conclui-se que o saneamento básico não está suficientemente abordado nos instrumentos de enfrentamento às arboviroses o que pode contribuir para a baixa efetividade de intervenção pública e que, portanto, tal contradição precisa ser superada pelas políticas públicas no Brasil.

Abstract Arboviruses, especially those transmitted by the Aedes aegypti mosquito, have become a serious public health problem in Brazil. In order to analyze how sanitation is addressed in the basic guidelines of public policies to control arboviruses in the country, content analysis was performed on eight governmental reference documents. As a result, it was possible to identify that aspects related to communication and social mobilization, vector control, and management are the themes most addressed in the documents analyzed. On the other hand, the components of basic sanitation, especially rainwater management and drainage, and sewage control, are not addressed in the instruments. Intersectorality is mentioned, however, there are no specific proposals to implement the plan and ensure its implementation. The Ministry of Health's National Guidelines for the Prevention and Control of Dengue Epidemics is the most complete document on the subject. The conclusion drawn is that basic sanitation is not sufficiently addressed in the instruments for combatting arboviruses, which can contribute to the low effectiveness of public intervention and, consequently, this discrepancy needs to be focused on by public policies in Brazil.

It's time to take a sustainable approach to health care in the face of the challenges of the 21st century.

Health challenges in the 21st century have become increasingly complex and global. The recent COVID-19 pandemic has only exacerbated the many problems faced by health care systems around the world and sadly, exposed various flaws. With ageing populations, particularly in Canada, as well as unavoidable factors such as globalization and accelerating climate change, it is becoming imperative to implement a new health care approach based on intersectorality and interdisciplinarity. Furthermore, links must be forged between all the stakeholders, i.e. the researchers, the health system and its specialists, the communities and the individuals themselves. It is in this perspective, where everyone concerned must be equally involved in attaining a better quality of life, that the concepts of One Health and sustainable health must be deployed.

Iniciativas da sociedade e comunidades no apoio social a grupos vulneráveis no território: papel da ESF na pandemia / Civil society and community social support initiatives for vulnerable groups in primary care center catchment areas: the role of the FHS during the pandemic

Resumo A pandemia ressaltou novos e antigos riscos à saúde que demandam ações sanitárias e formas de apoio social. Este artigo analisou o conhecimento dos profissionais de saúde de UBSs sobre iniciativas da sociedade e dos serviços de saúde, articulados ou separadamente na promoção de saúde e apoio social a grupos vulneráveis. Partiu-se da revisão teórica sobre o conceito e sua aplicação e da análise de dados empíricos do estudo multidimensional "Desafios à APS no enfrentamento da COVID-19", de desenho transversal, com amostra representativa das UBSs brasileiras, em nível nacional e regional. Gerou-se escore a partir de variáveis selecionadas e agregadas e estimou-se proporções de ações selecionadas e IC (95%), no Brasil e suas regiões. Ações a partir das UBSs e da população mostraram-se heterogêneas entre as regiões, sendo significativamente mais frequentes na região NE e em municípios não urbanos e de menor IDH, associando-se às ações desenvolvidas no território pelos ACS. Identificaram-se desafios, lacunas e necessidade de novas investigações; amplificação da magnitude e escopo de ações intra/intersetoriais; fortalecimento de laços entre diferentes atores e reversão dos efeitos da pandemia que aprofundaram desigualdades e iniquidades em saúde.

Abstract The pandemic highlighted new and old health risks that require health actions and social support. This study analyzed the knowledge of health professionals working in primary health care centers (PHCCs) regarding civil society and health service separately or along with health promotion and social support initiatives targeting vulnerable groups. The article begins by discussing the concept of social support and then goes on to present an analysis of empirical data from the multidimensional cross-sectional study "Challenges facing primary health care in the response to COVID-19 in the SUS", conducted using a nationally representative sample of PHCCs. Scores were calculated for selected and aggregated variables, and we calculated percentages for selected actions together with 95% confidence intervals at national and regional level. The percentage of PHCCs that supported actions and where the local community developed initiatives in the catchment area varied across regions, with rates being significantly higher in the Northeast and in non-urban municipalities with low MHDI, which was associated with actions developed in the catchment area by community health workers. The findings reveal several gaps and challenges, including the need to amplify the magnitude and scope of intra and intersectoral actions, strengthen ties between different actors, reverse the effects of the pandemic on health inequities and promote further research.

Intersetorialidade e saúde nas políticas estaduais de segurança pública e de prevenção à violência no Brasil / Intersectorality and health in state public security and violence prevention policies in Brazil

Resumo O presente estudo tem como objetivo compreender de que forma os Planos Estaduais de Segurança Pública (PSP) incorporam a perspectiva da prevenção da violência e da intersetorialidade, com especial atenção para o papel do setor Saúde. Trata-se de um estudo qualitativo que utilizou as técnicas de análise documental e de conteúdo, tendo como material empírico os PSP implementados ou em fase de formulação. Foram identificados 14 PSP. Todos os planos incorporam as concepções de prevenção da violência, intersetorialidade e participação do setor saúde. A concepção de prevenção da violência decorre do conceito de segurança cidadã, mas ações específicas de prevenção são mencionadas de forma genérica. A incorporação da intersetorialidade é heterogênea e insuficiente, na medida em que a participação dos setores na fase de planejamento não é a regra. A participação do setor saúde nem sempre é ativa, ou seja, desde a fase de planejamento das ações, as quais, na maioria das vezes, são pontuais e assistenciais. O setor saúde assume, ainda, um papel secundário, sem que suas experiências e potencialidades sejam reconhecidas. Concepções de prevenção da violência, intersetorialidade e participação do setor saúde, estão presentes nos planos de forma incipiente. Ressalta-se a importância de novos estudos.

Abstract The scope of this study is to understand how State Public Security Plans (PSP) incorporate the perspective of violence prevention and intersectorality, with special attention to the role of the health sector. It is a qualitative study that used the techniques of document and content analysis, having the PSP either implemented or in the formulation stage as empirical material. A total of 14 PSP were identified. All plans incorporate the concepts of violence prevention, intersectorality and participation of the health sector. The concept of violence prevention stems from the concept of citizen security, but specific prevention actions are mentioned in a generic way. The incorporation of intersectorality is heterogeneous and insufficient, to the extent that the participation of sectors in the planning phase is not the rule. The participation of the health sector is not always active, that is, from the planning phase of the actions, which, most of the time, are timely and care-based. The health sector also assumes a secondary role, without its experience and potential being recognized. Conceptions of violence prevention, intersectorality and participation of the health sector are present in the plans in an incipient way. The importance of new studies is emphasized.

Perspectiva teórica del empoderamiento intersectorial por la salud pública en directivos y líderes comunitarios / Theoretical perspective of intersectoral empowerment by public health in community managers and leaders

Introducción: La salud pública es la expresión de un complejo conjunto de factores en los que concurren elementos de diferente índole en estrecho vínculo con las políticas, sectores y actores económicos y sociales. Por ello, la gestión de cualquier proceso de salud, bienestar y calidad de vida requiere la concurrencia y alianza de los sectores implicados con un propósito común, lo que se logra a través de la intersectorialidad. Sin embargo, la participación consciente de los directivos y líderes comunitarios estaría mediada por su empoderamiento intersectorial por la salud pública. Objetivo: Elaborar una perspectiva teórica operacional del empoderamiento intersectorial por la salud pública en directivos y líderes comunitarios. Métodos: Investigación de desarrollo tecnológico. Posterior a la consulta bibliográfica para el planteamiento teórico se establecieron diferentes conceptos y definiciones sobre el empoderamiento intersectorial por la salud pública y sus dimensiones, que fueron validadas en consulta a expertos, los criterios emitidos permitieron añadir, eliminar o modificar y llegar a la versión final. El procesamiento estadístico fue a través de la razón de validez e índice de validez de contenido, según el modelo de Lawshe modificado por Tristán. Resultados: Se lograron conceptos y definiciones claras, coherentes y relevantes cuyos índices de validez de contenido global y aceptable en cada aspecto coincidió en 0,84, 0,78 y 1,00, respectivamente. La perspectiva teórica global fue satisfactoria. Conclusiones: Se obtuvo una perspectiva teórica operacionalizada para el empoderamiento intersectorial como constructo integrado a partir de la cual se podrán delimitar elementos que posibiliten su diagnóstico en directivos y líderes de los sectores de la comunidad(AU)

Introduction: Public health is the expression of a complex set of factors in which elements of different kinds concur in close link with policies, sectors and economic and social actors. Therefore, the management of any process of health, well-being and quality of life requires the concurrence and alliance of the sectors involved with a common purpose, which is achieved through intersectorality. However, the conscious participation of community leaders and managers would be mediated by their intersectoral empowerment by public health. Objective: Develop an operational theoretical perspective of intersectoral empowerment by public health in community managers and leaders. Methods: Research of technological development. After the bibliographic consultation for the theoretical approach, different concepts and definitions were established on intersectoral empowerment by public health and its dimensions, which were validated in consultation with experts, the criteria issued allowed to add, eliminate or modify and reach the final version. Statistical processing was through the validity ratio and content validity index, according to the Lawshe model modified by Tristan. Results: Clear, coherent and relevant concepts and definitions were achieved, whose indexes of validity of global and acceptable content in each aspect coincided in 0.84, 0.78 and 1.00, respectively. The overall theoretical perspective was satisfactory. Conclusions: An operationalized theoretical perspective was obtained for intersectoral empowerment as an integrated construct from which elements that enable its diagnosis can be delimited in managers and leaders of the community sectors(AU)

Centro Pop e Intersetorialidade: o problema da articulação com a rede de saúde mental / Centro Pop and Intersectorality: the problem of the articulation with the mental health network

Resumo O cuidado em saúde mental para a população em situação de rua (PSR) é um tema importante, mas sustentado por diversos estudos como subexplorado. Diante da complexidade desta demanda, temos diversos serviços no Sistema Único de Saúde (SUS) e no Sistema Único de Assistência Social (SUAS) que requerem trabalho intersetorial articulado em rede, não obstante, estudos apontam variadas falhas em sua execução. Neste estudo estatístico secundário, propomos a discussão desta articulação baseada nos resultados do Censo SUAS 2019. Participantes: 228 Centros Pop, de 25 estados brasileiros. Escolhidas para análise as variáveis do bloco de questões referentes à articulação do Centro Pop com CAPS e hospitais e utilizada a Análise de Correspondência Múltipla (ACM) para estabelecer associações entre variáveis e suas categorias. Resultados apontam articulação moderadamente satisfatória com os CAPS e insatisfatória em relação aos hospitais. Conclui-se que a articulação do Centro Pop com o CAPS é relevante principalmente nos municípios de grande porte e incipiente com os hospitais, independentemente do porte populacional. Destaca-se o protocolo de fluxo como importante ferramenta para a efetiva intersetorialidade na atenção em saúde à PSR e no direito à cidade e sugere-se estudos longitudinais sobre o tema, para auxílio na tomada de decisão.

Abstract Mental health care for the homeless population (HP) is an important topic but supported by several studies as underexplored. Given the complexity of this demand, there are several services in the SUS and SUAS that require an intersectoral work articulated in a network; however, studies point out several flaws in their performance. In this secondary statistical study, we propose a discussion of this articulation based on the results of the SUAS 2019 CENSUS. Participants: 228 Centro Pops, from 25 Brazilian states. Variables from the block of questions related to the articulation of the Centro Pop with CAPS and hospitals were chosen for analysis and the Multiple Correspondence Analysis (MCA) was used to establish associations between variables and their categories. The results show a moderately satisfactory articulation with the CAPS and unsatisfactory in relation to the hospitals. It is concluded that the articulation of the Centro Pop with the CAPS is relevant mainly in large municipalities, and incipient with hospitals, regardless of the population size. The flow protocol is highlighted as an important tool for effective intersectorality in health care for the HP and the right to the city, and longitudinal studies on the subject are suggested, to aid in decision-making instances.

Promoción de salud bucal desde la intersectorialidad / Oral Health Promotion from an Intersectoral Approach

Introducción: Para mejorar el estado de salud bucal es imprescindible la labor de promoción de salud y buscar métodos más novedosos desde edades tempranas. Así, la intersectorialidad se presenta como solución. Objetivo: Describir la necesidad de la promoción de salud bucal desde la intersectorialidad constatada en la bibliografía revisada. Métodos: Se realizó una revisión bibliográfica, donde se analizaron artículos publicados en idioma español, inglés y portugués. Se utilizaron 47 referencias bibliográficas de textos publicados en el período comprendido de enero de 2020 a mayo de 2021. Se consultaron las bases de datos bibliográficos y directorios como Scopus, SciELO, Medline y Libros de la Editorial de Ciencias Médicas mediante las palabras clave y operadores booleanos, para ampliar los resultados: promoción de salud AND (salud bucal OR promoción de salud bucal), promoción de salud bucal AND intersectorialidad. Con un enfoque actualizado se trató el tema de la salud bucal, la promoción de salud, promoción de salud bucal, intersectorialidad tanto a nivel internacional y en Cuba, lo que demuestra su importancia. Conclusiones: De acuerdo a los contextos actuales, la promoción de salud bucal tiene gran importancia en el desarrollo integral (biopsicosocial), desde la intersectorialidad. Por tanto, desde esta perspectiva, la promoción de la salud con la vinculación de varios sectores es la estrategia indicada para mejorar la salud bucal desde edades tempranas, lo cual permitirá perfeccionar la gestión de la atención de salud(AU)

Introduction: In order to improve the state of oral health, it is essential to work on health promotion and to look for more innovative methods from early ages. Thus, intersectorality is presented as a solution. Objective: To describe the need for oral health promotion based on intersectorality as it is reflected in the literature reviewed. Methods: A bibliographic review was carried out, during which articles published in Spanish, English and Portuguese were analyzed. Forty-seven bibliographic references of texts published in the period from January 2020 to May 2021 were used. Bibliographic databases and directories such as Scopus, SciELO, Medline were consulted, together with books from the medical sciences publishing house ECIMED, using keywords and Boolean operators to expand the results: promoción de salud [health promotion] AND (salud bucal [oral health] OR promoción de salud bucal [oral health promotion]), promoción de salud bucal [oral health promotion] AND intersectorialidad [intersectorality]. With an updated approach, the topics of oral health, health promotion, oral health promotion, intersectorality were addressed both internationally and in Cuba, demonstrating its importance. Conclusions: According to current contexts, oral health promotion is of great importance for comprehensive development (biopsychosocial), from intersectorality. From this perspective, health promotion, with the participation of several actors, is therefore the indicated strategy to improve oral health from early ages, which will allow improving health care management(AU)

Intersectorialidad en la prevención y control de enfermedades no trasmisibles. Santa Rita. Jiguaní. 2020

Se realizó un estudio descriptivo de corte transversal cualicuantitativo para describir cómo perciben los directivos, decisores y líderes sociales las acciones intersectoriales para la prevención y control de las Enfermedades no Transmisibles, en el Consejo Popular Santa Rita perteneciente al área de salud Policlínico Docente "David Moreno Domínguez", durante el periodo comprendido entre el año 2019 y 2020. La muestra estuvo constituida por un universo de 99 actores de organismos y organizaciones sociales, donde fueron seleccionados 63 de ellos por muestreo aleatorio simple, a los cuales se les aplicó una encuesta elaborada por el autor al respecto. El incremento de pacientes con Enfermedades no Transmisibles descompensadas que acuden a los consultorios médicos de familia y los servicios de urgencias, debido entre otras causas a las fallas en las acciones intersectoriales se convirtió en el problema de salud para estudio. Los directivos de salud, líderes sociales y decisores tuvieron la mayor percepción sobre el concepto de Intersectorialidad, predominó la participación intersectorial de forma inducida, con un pobre reconocimiento de los sectores que deben participar en los procesos intersectoriales para la prevención y control de estas enfermedades, prevalece el desconocimiento sobre el consejo local por la salud como escenario principal para la discusión y ejecución de acción intersectoriales, existiendo un predominio entre los participantes, que el funcionamiento de la Intersectorialidad en el Consejo Popular de Santa Rita es deficiente para la prevención y control de las Enfermedades no transmisibles.

A descriptive, qualitative-quantitative cross-sectional study was carried out to describe how managers, decision-makers and social leaders perceive intersectoral actions for the prevention and control of Non-Communicable Diseases, in the Santa Rita Popular Council, belonging to the "David Moreno Domínguez" Teaching Polyclinic" health area, during the period between 2019 and 2020. The sample consisted of a universe of 99 actors from organizations and social organizations, where 63 of them were selected by simple random sampling, to which a survey prepared by the author about it. The increase in patients with decompensated Non-Communicable Diseases who attend family doctors' offices and emergency services, due to failures in intersectoral actions, among other causes, became the health problem for study. Health managers, social leaders and decision-makers had the greatest perception of the concept of Intersectoriality, the intersectoral participation prevailed in an induced way, with poor recognition of the sectors that should participate in the intersectoral processes for the prevention and control of these diseases, Ignorance prevails about the local council for health as the main setting for the discussion and execution of intersectoral action, with a predominance among the participants that the functioning of the Intersectorality in the Popular Council of Santa Rita is deficient for the prevention and control of Non communicable Diseases.

Realizou-se um estudo descritivo, qualitativo-quantitativo transversal, como objetivo de descrever como gestores, tomadores de decisão e lideranças sociais percebem as ações intersetoriais de prevenção e controle das Doenças Não Transmissíveis, no Conselho Popular Santa Rita, pertencente ao "David Policlínica de Ensino Moreno" área da saúde, Domínguez" no período entre 2019 e 2020. A amostra foi constituída por um universo de 99 atores oriundos de organizações e organizações sociais, sendo 63 deles selecionados por amostragema leatória simples, para a qual foi elaborado um inquérito pelo autor sobre isso. O aumento de pacientes com Doenças Não Transmissíveis descompensadas que procuram consultórios médicos de família e serviços de emergência, devido a falhas nas ações intersetoriais, entre outras causas, tornou-se o problema de saúde em estudo. Gestores de saúde, lideranças sociais e tomadores de decisão tiveram maior percepção do conceito de Intersetorialidade, a participação intersetorial prevaleceu de forma induzida, com pouco reconhecimento dos setores que deveriam participar dos processos intersetoriais de prevenção e controle dessas doenças, Prevalece o desconhecimento sobre o conselho local de saúde como principal cenário para a discussão e execução da ação intersetorial, com predomínio entre os participantes de que o funcionamento da Intersetorialidade no Conselho Popular de Santa Rita é deficiente para a prevenção e controle das Doenças Não Transmissíveis.

Intersetorialidade e redes sociais: a implementação de projetos para população em situação de rua em São Paulo / Intersectorialidad y redes sociales: la implementación de proyectos para personas sin hogar en São Paulo / Intersectorality and social networks: the implementation of programs for homeless people in São Paulo

Resumo Para além da defesa normativa e prescritiva da intersetorialidade, sabe-se pouco sobre os condicionantes de sua implementação. O objetivo deste artigo é suprir essa lacuna, usando uma estratégia analítico-metodológica baseada nos estudos acerca de implementação e metodologia da análise de redes sociais (ARS). Com base em dados primários coletados em entrevistas aprofundadas e analisados por meio da ARS, o texto compara duas ações intersetoriais destinadas à população em situação de rua: o projeto Oficina Boracea, desde seu início, em 2002, até 2016, e o programa De Braços Abertos (DBA), a partir de sua formulação, em 2013, até seu término, em 2016. Os resultados indicam que, mais do que um modelo de gestão bem-formulado, a intersetorialidade é um produto de interações cotidianas e estratégias de coordenação construídas entre diferentes escalões da burocracia e entre atores estatais e não estatais, em distintos arranjos de implementação.

Resumen Con excepción de la defensa normativa y prescriptiva de la intersectorialidad, poco se sabe sobre las condiciones para su implementación. El objetivo de este artículo es llenar ese vacío, utilizando una estrategia analítico-metodológica basada en estudios de implementación y en la metodología de análisis de redes sociales (ARS). A partir de datos primarios recopilados a través de entrevistas en profundidad y analizados mediante ARS, este artículo compara dos proyectos intersectoriales para personas sin hogar: el proyecto Oficina Boracea, desde su inicio en 2002 hasta 2016, y el programa De Braços Abertos (DBA), desde su formulación en 2013 hasta su finalización en 2016. Los resultados indican que, más de un modelo de gestión bien formulado, la intersectorialidad es el producto de interacciones cotidianas y estrategias de coordinación construidas entre diferentes niveles de burocracia y entre actores estatales y no estatales, en diferentes arreglos de implementación.

Abstract Apart from the normative and prescriptive defense of intersectorality, the conditions related to the implementation of intersectoral programs are still little explored. This article aims to fill this gap, using an analytical-methodological strategy based on studies on implementation and the methodology of social network analysis (SNA). Based on primary data collected through in-depth interviews and analyzed using SNA, this article compares two programs for homeless people: the Oficina Boracea program, from its beginning in 2002 to 2016, and the program De Braços Abertos (DBA), from 2013 when it started until its end, in 2016. The results indicate that intersectorality is more than a well-designed management model. It is the product of everyday interactions and coordination strategies built with the participation of different levels of bureaucracy and state and non-state actors, gathered in different implementation arrangements.

Análisis del proceso técnico político de la ordenanza municipal para promoción de salud de Quillota

RESUMEN Para contribuir a la vida sana de la comunidad y en atención a las recomendaciones nacionales e internacionales para combatir la obesidad y sus consecuencias, en 2017 la Municipalidad de Quillota promulgó una Ordenanza de Promoción de Salud para favorecer entornos alimentarios saludables y para la práctica de actividad física. No está descrito en qué consiste y cuáles son las dificultades para establecer este tipo de normativas locales. El objetivo de este estudio fue analizar el proceso técnico y político que culminó en la generación de esta Ordenanza como ejemplo para el resto de los municipios del país. Con un diseño cualitativo, exploratorio y retrospectivo se recolectó información a través de entrevistas, grupos focales y diálogos participativos. Se realizó un mapeo de actores y el análisis de las lecciones aprendidas, considerando barreras y facilitadores. Los resultados muestran que la Ordenanza representó un desafío para la toma de decisiones que habilitaron su consolidación tanto en términos de gestión técnica como en los niveles de poder. Entre las lecciones aprendidas destaca la relevancia de un escenario político favorable, un equipo técnico competente y con liderazgo, y la fuerte articulación intersectorial; siendo clave la voluntad de las autoridades municipales y la negociación con sectores de oposición. La participación comunitaria activa fue un punto de compleja implementación.

ABSTRACT With the aim of improving the health of the community and given national and international recommendations to combat obesity and its consequences, in 2017, the Municipality of Quillota enacted a Health Promotion Ordinance to promote healthy food environments and physical activity practices. The ordinance is not specifically detailed, nor are the difficulties in establishing such local regulations described. Thus, this study intended to analyze the technical and political processes that generated this ordinance, which may serve as an example for other municipalities. The information collection was made through interviews, focus groups, and participatory dialogues, using a qualitative, exploratory, and retrospective design. Actors mapping and lessons learned analysis, considering barriers and facilitators found, was conducted. The results show that the ordinance consolidation presented a challenge to the decision-making management at the technical and empowerment levels. Lessons learned include favorable political scenarios, a competent technical team, and strong cross-sectoral articulation. Two key factors were the municipal authorities' resolution and negotiation with opposition sectors. Active community participation was a point of complex implementation.

Obesity agenda in Brazil, conflicts of interest and corporate activity.

Obesity is a social and health problem of global dimensions that demands coordinated solutions from different sectors as well as intersectoral efforts to overcome it. However, policies to overcome obesity affect the interests of the commercial private sector. In Brazil, the Intersectoral Strategy for Obesity Prevention and Control (EIPCO) is the result of participative public action and integrates a set of policies in the field of food and nutrition security. Based on the premise that EIPCO expresses public interests to be protected, promoted and guaranteed by the federal government, this article aims to analyze corporate political activity (CPA) and conflict of interest (COI) situations involving the private commercial sector in the food and nutrition field in Brazil, using EIPCO as a reference. The methods include document analysis and identification of cases reported by the Brazilian civil society organizations that are part of the National Council on Food and Nutrition Security. The results highlighted the actors, actions, ideas and interests addressed by EIPCO and also indicated that EIPCO does not question the private commercial sector's practices in regard to obesity and some of its recommended actions reflect disputes about the concept of healthy eating. All cases analyzed involved CPA to promote ultra-processed food consumption, including lobbying and funding researchers. Those practices and goals are in the opposite direction from the objectives of EIPCO to overcome obesity which indicates potential COI once these representatives of the private sector are directly influencing the governmental political process and policies.

Analyzing vulnerable children and adolescents' health promotion in a civil-society organization in Florianopolis-SC / Analisando a promoção à saúde de crianças e adolescentes em vulnerabilidade em uma organização da sociedade civil em Florianópolis-SC

Abstract After the redemocratization, partnerships between the State and civil-society organizations have been guaranteed by the Constitution as a democratic tool. With the rise of neoliberalism and the decrease in State investments in social policies, such organizations have become protagonists in the health care, education, and protection of children in vulnerable situations. This study aims to analyze health promotion in the care for children and adolescents in a Civil-Society Organization (CSO) in Florianopolis-SC, Brazil. This is a case study with a qualitative approach in which semi-structured interviews were conducted, transcribed and analyzed using the thematic analysis method. The analysis resulted in two empirical categories: (1) Weaving networks between the State and Civil Society: intersectorality in health promotion; and (2) CSOs and the paths and deviations in pursuit of emancipatory health promotion. The analysis showed that, although CSOs include several health promotion initiatives for children and adolescents, intersectoral work still lacks effectiveness. Moreover, for emancipatory health promotion, it is necessary to work towards community empowerment and education for critical and social reflection.

Resumo Após a redemocratização, as parcerias entre o Estado e as organizações da sociedade civil são garantidas pela Constituição como ferramenta democrática. Com advento do neoliberalismo e a diminuição de investimento estatais em políticas sociais, essas organizações se tornam protagonistas no cuidado com a saúde, a educação e a proteção de crianças em situação de vulnerabilidade. Este trabalho tem como objetivo analisar a promoção à saúde no atendimento de crianças e adolescentes em uma Organização da Sociedade Civil (OSC) de Florianópolis-SC. Trata-se de estudo de caso com abordagem qualitativa na qual foram realizadas entrevistas semiestruturadas, que foram transcritas e analisadas a partir do método de análise temática. A análise inferiu em duas categorias empíricas: (1) Tecendo redes entre o Estado e a Sociedade Civil: a intersetorialidade na promoção à saúde; e (2) A OSC e os (des)caminhos em busca da promoção à saúde emancipatória. A análise apresentou que, apesar de a OSC incluir diversas iniciativas de promoção à saúde para crianças e adolescentes, ainda falta a efetivação do trabalho intersetorial; além disso, para uma promoção à saúde emancipatória, é necessário atuar em direção ao empoderamento da comunidade e da educação para reflexão crítica e social.

Covid-19 - An effective municipal coordination and articulation exercise: the Niterói experience / Covid-19 - Un efectivo ejercicio de coordinación y articulación municipal: la experiencia de Niterói / Covid-19 - Um exercício de coordenação e articulação municipal efetiva: a experiência de Niterói

This article aims to present an experience of the City of Niterói regarding the creation and coordination of coping actions in COVID-19. The planning and implementation of the different strategies was based on intersectorality as the transversal management line, considering, based on the impact factors of the pandemic on the population, not only the one-dimensional aspect of responsibility of the clinical studies of COVID-19, but with the treatment vulnerability conditions, socioeconomic impacts of mitigation measures and social determinants of health. For such, the construction of an intersectoral management model with the creation of a Crisis Office formed by representatives of different secretaries, resulted in actions that aimed to respond to the specific needs of life, without continuous communication with a population in order to guarantee access with information and support of society, a central factor in monitoring mitigation measures.

Este artículo se propone presentar la experiencia del municipio de Niterói en la creación y coordinación de las acciones de combate a COVID-19. La planificación y la implementación de las diferentes estrategias se basó en la intersectorialidad como línea de gestión transversal, considerando, a partir de los factores de impacto de la pandemia en la sociedad, no sólo el aspecto unidimensional de la responsabilidad del ámbito clínico del COVID-19, sino también la complejidad de la atención de las condiciones de vulnerabilidad, los impactos socioeconómicos de las medidas de mitigación y los determinantes sociales de la salud.Para ello, la construcción de un modelo de gestión intersectorial con la creación de un Grupo de Crisis formado por representantes de diferentes secretarías, dio como resultado acciones que buscaban responder a las necesidades propias de la complejidad de la vida, en la comunicación continua con la población para garantizar el acceso a la información y la adhesión de la sociedad, factor central para el éxito de las medidas de mitigación.  

Este artigo visa apresentar a experiência do município de Niterói na criação e coordenação das ações de enfrentamento à COVID-19. O planejamento e implementação das diferentes estratégias foi embasado na intersetoralidade como linha transversal de gestão, considerando, a partir dos fatores de impacto da pandemia na população, não apenas o aspecto unidimensional de responsabilidade do âmbito Clínico da COVID-19, mas a complexidade do cuidado das condições de vulnerabilidade, dos impactos socioeconômico das medidas de mitigação e dos determinantes sociais da saúde. Para tal, a construção de um modelo de gestão intersetorial com criação de um Gabinete de Crise formado pelos representantes de diferentes secretarias, resultou com ações que objetivaram responder às necessidades pertinentes à complexidade da vida, na comunicação contínua com a população em modo a garantir do acesso à informações e adesão da sociedade, fator central no êxito das medidas de mitigação.

Integrated vector control of Chagas disease in Guatemala: a case of social innovation in health.

BACKGROUND: Improved access to health care and quality of services require integrated efforts and innovations, including community empowerment and participation in transformation processes. Chagas disease is a neglected tropical disease that is generally controlled by insecticide spraying. To achieve community empowerment in a health program, actions for social innovations may include: community-based research, interdisciplinary and intersectoral participation, community perception of direct benefits and participation in health or environmental improvements. The aim of this study was to describe and analyze the processes by which an interdisciplinary team, in collaboration with communities of Comapa, Guatemala, developed an effective solution to address the risk for Chagas disease. METHODS: A qualitative study involving interviews semi-structured and direct observation was conducted using a case study approach to describe and understand the community-based research and intervention process developed by researchers from the Laboratory of Applied Entomology and Parasitology of the Universidad de San Carlos of Guatemala (Laboratorio de Entomologia y Parasitologia Aplicada). Nine interviews were conducted with the investigators, innovators, members of the community in which the intervention had been implemented. NVivo software (version 12) was used for the emergent coding and analysis of the interviews. RESULTS: Processes of social transformation were evident within households, and the communities that transcended the mere improvement of walls and floors. New social dynamics that favored the household economy and conditions of hygiene and home care that positively impacted the health of the community. We describe how the integration of criteria of social innovation into a home improvement strategy for Chagas disease control, can generate processes of transformation in health by considering sociocultural conditions, encouraging dialogue between public health approaches and traditional practices. We identify and discuss processes for Social Innovations in Health and identify their potential in improving community health in Latin America. CONCLUSIONS: When social innovation criteria are included in a health control initiative, the community-based research and the interdisciplinary and intersectoral participation facilitate the implementation of the control strategy, the perceived benefits by the community and its empowerment to sustain and share the strategy. The case study provided understanding of the intersectoral and interdisciplinary dynamics in particular contexts, and documented the relevance of innovation criteria in health processes.

Redes de política pública: un abordaje para analizar la gobernanza de la Seguridad Alimentaria y Nutricional / Public policy networks: an approach to analyze the governance of Food and Nutrition Security

Resumen El concepto de gobernanza adquiere cada vez más relevancia en los debates y práctica de la gestión de estrategias políticas de Seguridad Alimentaria y Nutricional (SAN). Sin embargo, su análisis demuestra una complejidad por la influencia de actores locales, regionales, nacionales e internacionales. El enfoque sistémico de la SAN contempla, dentro de otros principios, la participación y la intersectorialidad, tales estrategias parten de una perspectiva multidisciplinaria que no presupone homogeneidad, sino que se conforma de diversos actores y sus distintas formas de relacionamiento multinivel. Para comprenderlo, este artículo propone una ruta teórico-metodológica que consiste en el análisis de actores involucrados en determinada problemática, utilizando las contribuciones del abordaje de las Redes de Política Pública (RPP). Las herramientas analíticas de dicho abordaje ofrecen caminos para delimitar el estudio y definir cómo y quiénes ejercen la gobernanza en la SAN del contexto a estudiar.

Abstract The concept of governance acquires more and more relevance in the debates and practice of the management of political strategies of Food and Nutrition Security (FSN). However, its analysis demonstrates a complexity due to the influence of local, regional, national and international actors. The systemic approach of the FNS contemplates participation and intersectorality, among other principles. Such strategies are based on a multidisciplinary perspective that does not imply homogeneity, but rather consists on diverse actors and their different forms of multilevel relationship. In order to clarify it, this article proposes a theoretical-methodological route that consists on the analysis of actors involved in a given problem using the contributions of the Public Policy Networks (PPN) approach. The analytical tools of this approach offer ways to delimit the study and define the way, as well as who exercises the governance in FSN under the context to be studied.

Estratégias de intra e intersetorialidade para transversalizar a saúde do trabalhador em todos os níveis de atenção à saúde / Strategies of intra and intersectorality to integrate the occupational health at all healthcare levels

Resumo Objetivo: descrever o papel e as ações conduzidas pelo Centro de Referência em Saúde do Trabalhador (Cerest) de São Bernardo do Campo (SP) para a implementação da política de saúde do trabalhador no município, entre 2010 e 2016. Métodos: o relato de experiência foi baseado em reflexões coletivas associadas à análise de documentos - relatórios, memórias de reunião, planos de trabalho do Cerest, Planos Municipais de Saúde - sobre as ações do serviço e sua construção intra e intersetorial. Resultados: coube ao Cerest o papel de fomentar o debate e problematizar as intervenções, introduzindo e disseminando na rede de saúde a atenção ao trabalhador. As ações do Cerest focalizaram o trabalho em rede buscando desenvolver o raciocínio clínico, epidemiológico e sociopolítico sobre a realidade sanitária da população. Foram construídas referências técnicas por meio do apoio matricial visando a implementação da notificação compulsória dos agravos relacionados à saúde do trabalhador na rede pública e privada, a articulação intersetorial, o fortalecimento da participação social e da articulação de ações regionais. Conclusão: fundada no compromisso ético-político que se impõe às ações de saúde, a experiência tem buscado instituir uma cultura da saúde do trabalhador no âmbito da saúde e do município, respeitando os princípios da integralidade do cuidado e da centralidade do trabalho.

Abstract Objective: to describe the role and the actions carried out by the Worker's Health Reference Center (Cerest) of São Bernardo do Campo, in the state of São Paulo, Brazil, in the implementation of the worker's health policy in the municipality between 2010 and 2016. Methods: this report on experience was based on collective reflections associated with the analysis of documents - reports, meeting minutes, Cerest's work plans, municipal health plans - on the Cerest actions and their intra and intersectoral structuring. Results: the Cerest's role was to foment the debate and to problematize the interventions by introducing and disclosing, in the health network, the workers' healthcare. Cerest's actions focused on the networking to develop a clinical, epidemiological and sociopolitical reasoning about the population's health reality. Technical references were built through matrix support aiming at implementing the compulsory notification of injuries related to occupational health in the public and private network, intersectoral articulation, strengthening of social participation and of regional actions' articulation. Conclusion: rooted in the ethic-political commitment imposed to health actions, the experience has been seeking to institute a culture of worker's health in the scope of the health system and municipality, agreeing with the principles of care completeness and work centrality.

O SUS e a Política Nacional de Promoção da Saúde: perspectiva resultados, avanços e desafios em tempos de crise / Brazil's Unified Health System and the National Health Promotion Policy: prospects, results, progress and challenges in times of crisis

Resumo O estudo analisa os avanços e desafios da implementação da Política Nacional de Promoção da Saúde (PNPS) quanto às suas agendas prioritárias e aponta aspectos críticos para sua sustentabilidade em tempos de crises. Estudo de revisão narrativa, abrangendo estudos publicados e documentação institucional. A PNPS foi aprovada em 2006 e revisada em 2014 e destaca a importância dos condicionantes e determinantes sociais da saúde no processo saúde-doença e tem como pressupostos a intersetorialidade e a criação de redes de corresponsabilidade que buscam a melhoria da qualidade de vida. Foram descritos avanços nas prioridades destacadas na PNPS, em programas e ações de enfrentamento ao uso do tabaco e seus derivados; alimentação adequada e saudável; práticas corporais e atividades físicas; promoção do desenvolvimento sustentável; o enfrentamento do uso abusivo de álcool e outras drogas; a promoção da mobilidade segura e sustentável; e a promoção da cultura da paz e de direitos humanos. Entretanto, os avanços da PNPS apresentados podem estar seriamente ameaçados frente à grave crise política, econômica e institucional que abateu o país, em especial os cortes orçamentários para os próximos 20 anos, com a Emenda Constitucional 95, desenhando um cenário futuro de muitas incertezas.

Abstract This article examines progress made towards the implementation of the core priorities laid out in the National Health Promotion Policy (PNPS, acronym in Portuguese) and current challenges, highlighting aspects that are essential to ensuring the sustainability of this policy in times of crisis. It consists of a narrative review drawing on published research and official government documents. The PNPS was approved in 2006 and revised in 2014 and emphasizes the importance of social determinants of health and the adoption of an intersectoral approach to health promotion based on shared responsibility networks aimed at improving quality of life. Progress has been made across all core priorities: tackling the use of tobacco and its derivatives; tackling alcohol and other drug abuse; promoting safe and sustainable mobility; adequate and healthy food; physical activity; promoting a culture of peace and human rights; and promoting sustainable development. However, this progress is seriously threatened by the grave political, economic and institutional crisis that plagues the country, notably budget cuts and a spending cap that limits public spending for the next 20 years imposed by Constitutional Amendment Nº 95, painting a future full of uncertainties.

Intersectorality and social participation as coping policies for health inequities-worldwide.

OBJECTIVE: To determine the impact that intersectoral policies and social participation, implemented worldwide, have had on the modification of the social determinants for health and on the reduction of social health inequities. METHOD: A scoping review of the literature published in the period 2005-2015 was performed. The literature search was conducted on PubMed and Scielo databases. Two researchers reviewed each document. Data were analysed according to the intersectoral action and social participation variables and according to the theoretical frameworks of the Social Determinants Model of the Commission on Social Determinants of Health (CSDH) and the theoretical constructs of Social Capital (SC) and Life Course (LC). RESULTS: Out of 45 documents likely to be selected for final review, all of them based on title and abstract, 20 documents were eventually picked out and analysed; most them (n = 8) were conducted in all Latin America and Latin America's countries. Twelve documents reported intersectoral action associated with social participation in partnership with different institutions. Regarding theoretical frameworks, most of studies (n = 8) used CSDH and SC. In relation to health outcomes, the studies showed mainly: increased access to health and education, follow-up of pregnant women, increasing in prenatal examinations, reduction in malnutrition/child mortality, reduction in extreme poverty/hunger; reduction in epidemics/tuberculosis, control of alcohol/drug consumption, promotion of health/mental as well as basic sanitation improvements. CONCLUSIONS: Intersectoral and social participation experiences studied yielded positive outcomes regarding health status and quality of life in the communities in which such experiences were implemented.

Em busca da vida intersetorial de Marilda: saúde mental e outras políticas públicas / Search of the intersetorial life of Marilda: mental health and other public policies

Esta pesquisa busca cartografar como acontece a intersetorialidade, cuja estratégia foi idealizada em várias conferências de políticas públicas brasileiras. Para tal, seguiu-se algumas pistas deixadas por profissionais implicados no caso de uma usuária de vários serviços públicos de um município da região metropolitana de Porto Alegre, a Marilda. Transitou-se por três setores envolvidos neste caso (saúde, justiça e assistência social) e entrevistou-se uma profissional de cada um destes serviços. Também, agregou-se ao acervo de dados uma consulta de prontuários e outros registros institucionais por onde ela andou em busca de uma vida melhor. Os referenciais da Análise Institucional compõem a análise dos dados com as diretrizes políticas dos Sistemas Únicos de Saúde e de Assistência Social. O método da pesquisa é a cartografia. Observaram-se algumas vias de diálogo entre as políticas assistenciais, alguns canais de comunicação fluidos, dificuldades e entraves, cujos (re)fluxos deixam algumas pistas de como se pode criar condições de possibilidade para se construir um caso intersetorial, complexo e coletivo.(AU)

This reQsearch aims to cartograph the way the intersectorality happens, a strategy idealized at various conferences of Brazilian public policy, by interviewing actors involved in the case of a user of several public services of a city in the metropolitan region of Porto Alegre, Marilda. The research seeks interlocutions between three sectors involved in this case - health, justice and social assistance ­ by interviewing a professional of each of these charts and also consulting medical records and other institutional records, from where she had been searching a better life. The Institutional Analysis references are articulated with the Single Health Systems (SUS) and Social Assistance (SUAS) policy guidelines. The research method is the cartography. It has been observed several channels of dialogue between the assistencial policies and fluid communication channels, even if there are still some positions far from reaching the construction of an intersectoral case, complex and collective.(AU)