Public health policies as guides for local public policies: the experience of Sobral-Ceará, Brazil

Abstract

Abstract:The accelerated urbanisation process that Brazil has gone through in the last 50 years has given rise to daunting challenges for public managers, especially in terms of local public policy management for the building of "healthy cities". In Sobral, a municipality of 173,000 inhabitants in Ceará in the North-eastern region of Brazil, a number of municipal policies were initiated beginning in 1997, many in partnership with the federal and state governments. They were inspired by the vision of a healthy and equitable city and were marked by strategic planning and the implementation of intersectoral projects. This article lays out some of the actions and their results, including an increase in the public supply of drinking water from 65% to 97% of households; an increase in sewage networks from 7% to 65%; an increase in public refuse collection from 42% to 90%; the expansion of green areas; the construction of nine kilometres of bicycle paths; the universalisation of integral health care through the Family Health Strategy through a network with specialised out-patient and hospital services; and a 148% increase in the number of children enrolled in primary school. These initiatives also resulted in the improvement of quality of life indicators, including a reduction in infant mortality from 61.4 to 19.0 per thousand live births, a drop in the mortality rate from traffic accidents from 33.40 per 100,000 inhabitants in 2001 to 15.25 in 2003; and a jump in literacy rates among children in the first cycle of primary school from 40 to 90.7%. In the present article, the authors describe some of the successful strategies and projects initiated between 1997 and 2003, and discuss how this experience could be reproduced in other communities across Brazil and around the world.

Urban Governance, Multisectoral Action, and Civic Engagement for Population Health, Wellbeing, and Equity in Urban Settings: A Systematic Review

“…According to the OECD classification, five studies reported data from a large metropolitan area ( 28 , 31 , 37 , 38 , 41 ). Sobral, Richmond, Rennes, Bristol, Ljubljana and Sosnowiec were classified as medium-sized urban areas ( 27 , 30 , 32 , 42 ); Barcelona, San Francisco, Lisbon, Detroit and Amsterdam were classified as metropolitan areas ( 33 , 36 , 40 , 42 ); and Noarlunga, Gulfport, Hermosa Beach, Redondo Beach and Manhattan Beach as small-size urban areas ( 29 , 34 , 43 ). Matsapha and Vancouver were classified as other urban settings ( 35 , 39 ).…”

“…As a lone process, multisectoral action to advance the construction of a healthy city was addressed in six (35%) studies ( 30 – 32 , 35 , 36 , 41 ). Five studies assessed both multisectoral action and health governance ( 27 , 29 , 33 , 38 , 39 ); three reported data on multisectoral action and civic engagement ( 34 , 37 , 40 ), and the same amount of studies assessed only civic engagement ( 28 , 42 , 43 ).…”

“…The radar charts in Supplementary Figure S1 allow for a visual comparison of the proportion of the targeted population among the studies ( Supplementary Figure S1A ), the focus of the studies ( Supplementary Figure S1B ), and the dimensions of indicators that were used ( Supplementary Figure S1C ). The general population was the target in 14 studies ( 27 , 29 – 33 , 35 – 37 , 39 – 43 ). Children were included in only three strategies ( 37 , 38 , 41 ) underserved populations in another three ( 30 , 34 , 41 ), youth in two ( 37 , 41 ), ethnic groups in two ( 30 , 34 ), and women ( 41 ), and the elderly ( 36 ) in one each.…”

“…Other tools and indexes were EuroQol, EnviroScreen, Urban Quality of Life Index, Life Evaluation Index (LEI), Cities Rapid Assessment Framework for Transformation (CRAFT) and the Population Health Index ( Table 2 ). As represented in Supplementary Table S2 , health indicators were reported in six studies ( 28 , 29 , 36 , 38 – 40 ); housing ( 28 , 32 – 34 , 36 , 40 ) and environmental indicators ( 28 , 33 , 34 , 36 , 40 , 42 ) in five of them; indicators on transportation ( 28 , 33 , 36 , 40 , 43 ), education ( 27 , 28 , 36 , 40 ), economic conditions and social protection in four ( 28 , 33 , 36 , 40 ); and infrastructure in three ( 28 , 33 , 36 ). A smaller proportion of studies (two) presented indicators for sanitation ( 34 , 39 ).…”

Interventions to improve pedestrian and cyclist safety in Latin America: a systematic review and metasummary

“…The final intervention demonstrated the impact of utilizing a multifaceted approach incorporating strategies from all Three E’s on VRU deaths in Brazil ( Monteiro Andrade et al, 2005 ). In 2005, Monteiro Andrade and colleagues documented a multifaceted urban development policy implemented in Sobral-Ceará, Brazil in 1997.…”