Intersectoriality on health

In the Region of the Americas, the concept of intersectorality in health is based on the Declaration of the International Conference on Primary Health Care Alma Ata – PAHO/WHO of 1978, which states that primary health care (PHC): “It involves, in addition to the health sector, all related sectors and various aspects of national and community development, especially agriculture, livestock, the food industry, education, housing, public services, communications and other sectors and calls for the coordinated efforts of all these sectors” (1);  as well as what was established in the 1986 Ottawa Charter on Health Promotion and the developments and debates that have taken place in the Region around Local Health Systems (SILOS): Challenges for the 1990s (paho.org) (2). 

However, since the adoption of the International Covenant on Economic, Social and Cultural Rights (ICESCR) in 1976, the impact of sectors other than health on the health of the population has been recognized, stating that “the right to health encompasses a wide range of socio-economic factors that promote the conditions under which people can lead a healthy life, and extends this right to the underlying determinants of health, such as food and nutrition, housing, access to safe and potable water and adequate sanitation, safe and healthy working conditions and a healthy environment” (3). 

In 2003, at the request of member countries, PAHO reviewed PHC – as a fundamental component of health systems – and proposed a renewal of PHC 25 years after its recognition, stating that a health system based on PHC should promote intersectoral actions between the health sector and different sectors and actors to address the social determinants of health and solve health inequities, i.e., it should create, promote and maintain “….linkages between the public and private sectors, both within and outside health services, including, among others: employment and labor, education, housing, agriculture, food production and distribution, environment, water and sanitation, social protection and urban planning.” Therefore, in the Regional Declaration on the new PHC orientations (Declaration of Montevideo – New Orientations for Primary Health Care. [2005] – PAHO/WHO | Pan American Health Organization (paho.org)) of 2005, PAHO/WHO member states commit themselves to promoting intersectoral work to achieve the highest level of health for the population (4). Health is thus understood in a broader sense, beyond the restrictive notion of disease.

Subsequently, in the Rio Declaration on Social Determinants of Health, issued as a result of the meeting held in Rio de Janeiro, Brazil, in October 2011, the participating WHO member states expressed: “…our determination to achieve social and health equity through action on the social determinants of health and well-being, applying a comprehensive intersectoral approach“, as well as: “build, strengthen and sustain public health capacities, and in particular capacity for intersectoral action on the social determinants of health“; “implement intersectoral mechanisms such as the “health in all policies” approach to address health inequities and social determinants of health.”

The World Health Organization WHO defines the Social determinants of health (SDH) – PAHO/WHO | Pan American Health Organization (paho.org), as “the circumstances in which people are born, grow up, work, live and age, including the broader set of forces and systems that influence the conditions of daily life“. It is the set of social, political, economic, environmental and cultural factors that influence the health status of individuals and groups, as it includes aspects related to the distribution of power, income, goods and services, access to health care, schooling and education, work and leisure conditions, the state of housing and the physical environment, among others (5), (6), (7).

According to WHO, health inequities and inequalities persist in the Region of the Americas, hampering access to universal health and sustainable development, and the population is disproportionately affected by poor living conditions due to structural and social factors, such as ethnicity, cultural norms, income, education, and employment, among others, making it increasingly necessary to analyze these determinants (8).

In this context, addressing the social determinants of health, i.e., the socio-cultural, political, environmental and economic conditions in which people live, to achieve the transition to Universal Health Access and Coverage in the Region and to ensure comprehensive healthcare, means taking action and adopting intersectoral measures to address the problems that affect health but go beyond the health sector, as well as to reduce inequalities and unequal access to health services in countries.

In the case of Indigenous, Afro-descendant, Roma and other ethnic peoples, in order to comprehensively guarantee their rights -individual and collective- specifically the right to health, as well as access and universal coverage to health with equity and cultural relevance, the development of intersectoral actions is required, involving -in addition to the entities of the health sector – all those entities at the national, regional and local levels (public, private, academia, among others) that have competences or functions in aspects directly or indirectly related to health or that have effects on the state of health and access to health care (nutrition, basic sanitation, housing, education, employment, security, territorial protection, transportation, roads, communications and access to basic services such as drinking water and energy, among others).

Intersectoral actions which, according to the PAHO/WHO Policy on Ethnicity and Health (29th Pan American Sanitary Conference) – PAHO/WHO (Pan American Health Organization), the ethnic component (i.e., ethnicity) should also be considered as a social determinant of health since existing health disparities and inequities among different ethnic groups reflect different needs and worldviews, as well as different geographic, economic, and cultural barriers to access to health services for these populations (9).

Finally, in any action promoted by governments for the protection of health rights, the socio-cultural adaptation of health services and the development of comprehensive health policies with an intercultural and intersectoral approach, it is important to promote social participation, coordination and strategic alliances with indigenous, Afro-descendant, Roma and other ethnic population organizations, as appropriate in the national context.

References.

1. World Health Organization. Declaration of Alma Ata. International Conference on Primary Health Care. [Internet] 1978. https://www.paho.org/hq/dmdocuments/2012/Alma-Ata-1978Declaracion.pdf
2. Pan American Health Organization PAHO/WHO (2015). Intersectorality and equity in health in Latin America: an analytical approach. Special Program on Sustainable Development and Equity in Health (SDE).
3. Office in Colombia of the United Nations High Commissioner for Human Rights (OHCHR). The right to health. Compilation of national and international jurisprudence and doctrine. [Internet] 2003. Volume II. P. 290 et seq. Available at: https://www.ohchr.org/sp/professionalinterest/pages/cescr.aspx
4. Pan American Health Organization PAHO/WHO (2007). The Renewal of Primary Health Care in the Americas. [Internet] 2007. Pan American Health Organization/World Health Organization Position Paper. Available at: The Renewal of Primary Health Care in the Americas (paho.org).
5. World Health Organization. Commission on Social Determinants of Health. Document A62/9. [Internet] 2009. Report of the Secretariat. Sixty-second World Health Assembly, Item 12.5 of the provisional agenda. Available at: A62/9 (2009) – Commission on Determinants (PDF).
6. Pan American Health Organization PAHO/WHO (2012). Regional guidance document on the social determinants of health in the Region of the Americas. Special Program on Sustainable Development and Equity in Health (SDE).
7. World Health Organization (2008). Commission on Social Determinants of Health. Closing inequities in a generation: achieving health equity by acting on the social determinants of health. Analytical summary of the final report. https://apps.who.int/iris/handle/10665/69830
8. Pan American Health Organization (web). Social determinants of health in the region of the americas (2017). Available at: Health in the Americas 2017 (paho.org).
9. Del Pino, Sandra; Coates, Anna R.; Guzmán, José Milton; Gómez-Salgado, Juan and Ruiz-Frutos, Carlos. Ethnicity and health policy: building equitable solutions in the face of ethnic inequalities. [Internet] 2018. Spanish Journal of Public Health, vol.92. Available at: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1135-57272018000100308