This function exhibited an intermediate performance, with a median of 0.53 for the Region. Although most countries fall within intermediate values, the graph below helps to identify those that deviated from the regional average:
A fundamental objective of health promotion is to improve access to social support, safer communities, work opportunities, and better education. By expanding these protective factors, the health inequalities associated with low socioeconomic status can be reduced. Therefore, it is necessary that countries within the Region make the effort to improve the critical areas presented by this function.
As presented in the following graph, all of the indicators for this function exhibited intermediate performance:
The graph below shows that indicators 2, 3, and 5 exhibited less variation. There is more variation among the other indicators, thus confirming that health promotion is strong in some countries while weak in others.
The primary factors determining this function’s performance are:
• Most countries take into account the recommendations of international meetings on health promotion, and incorporate them into action plans. Forty-nine percent of the countries have established health promotion goals and have developed “healthy municipality” activities at the local level.
• A critical area is the poor development of systems for supporting health promotion at the sub-national levels. Twenty-three percent of the countries have recognition and reward programs for promotion activities, 35% of the countries have “award” funds designated for such interventions, and 76% of the countries finance training activities for health promotion personnel.
• Although policies and standards exist for promoting healthy behaviors and environments, only 43% of the countries create annual action plans for health promotion, which may help to explain the limited results.
• In general, systematic analysis by the NHA on the impact of public policy on health is lacking. Only 22% of the countries have resources to measure the impact of public policies on health.
• Approximately 35% of the countries stated that they have action plans to establish partnerships with other actors and sectors. Less than half of them evaluate the results periodically and correct any problems that are found.
• The NHA actively supports health promotion activities in all countries, especially in education at the local levels. There is also coordination with other actors, but the results are not evaluated. The use of television, radio, and the press is common to the majority of campaigns implemented by the countries. Only 14% of the countries have conducted campaigns using the internet.
• Organizations dedicated to educating and informing the public about health issues are scarce, and those that exist are not monitored. Less than a third of the countries use Web pages or telephone as tools in disseminating information.
• Nearly 70% of the countries promote the development of models in which the primary strategy is the provision of public health services by teams with training in health promotion. However, only 35% of the countries state that they have developed mechanisms to encourage a health promotion approach in primary health care.
• The countries emphasized the following as their main obstacles in reorienting health systems towards health promotion: only 5% of the countries have payment mechanisms to support health promotion; no country promotes health insurance schemes with an emphasis in health promotion; and most country health plans do not include activities in health promotion. Furthermore, the countries stressed the lack of recognition that exists for health promotion training in the process of professional accreditation.
• The countries stated that they have personnel trained in health promotion. Fifty-nine percent of the countries provide incentives for training centers to include health promotion in their academic curricula, and 78% include it in their human resources training programs.
• The main critical areas for the NHA are the lack of plans for strengthening health promotion at the sub-national levels and the need to improve the evaluation and support activities aimed at sub-national instances.