Intersectoral Action and Health Equity in Latin America: An Analytical Approach

Abstract

[Background]. Intersectoral action is a recurrent theme in public health management. However, there is very little systematic documentation on how it is implemented, especially in the field of health. Nor does an explicit theory exist on how to construct a framework in the health sphere to determine what kinds of intersectoral actions are feasible under different scenarios, or the kind of intersectoral action needed to address the social determinants of health and reduce inequities in health (Solar et al., 2009). This work proposes a preliminary conceptual framework to help identify and characterize experiences and studies on the intersectoral approach that have contributed to the objectives of health equity in Latin America in the past and present. We present elements of analysis to determine the context of the experiences and their specific features and scope, emphasizing the aspects that have characterized the origins and evolution of the intersectoral approach in the Region [...] In fact, in the Region of the Americas, the term “HiAP” has been almost completely absent from public policymaking. This seems to be because the concept is linked to a European social-historical context and, within this, to promotion of the concept by Finland’s European Union presidency in 2006. In the Region of the Americas, “intersectorality” has been the preferred concept, based on the Declaration of Alma-Ata of 1978 and its call for “health for all,” which had great influence in Latin America and the Caribbean. Added to this were the important contributions of the Ottawa Charter for Health Promotion in 1986 and, at the same time, developments and debates taking place in the Region of the Americas around Local Health Systems (SILOS). These were part of the health sector’s response to the democratization processes unfolding in the Region. The emphasis was on the need to reorganize and reorient health systems on the basis of decentralization and local development, and to strengthen and renew the primary care strategy approved in Alma-Ata, stepping up the effort to achieve equity with solidarity and justice for the entire population...