[An experience with public education in nutritional health in 2 communities in Jalisco, Mexico]

[Prevention of non-communicable diseases from governance and food security in Soraca, Colombia]

OBJECTIVE

To assess whether the municipality, in Colombia, is the appropriate setting for the development of food and nutrition security policies focused on the prevention of non-communicable diseases.

METHODS

Through the study of diabetes and obesity prevention in Soracá (Boyacá, Colombia), an analysis of the legal provisions related to non-communicable diseases and food and nutrition security (1990-2017) was carried out. Interviews were conducted with municipal and departmental actors, based on governance.

RESULTS

The municipality has direction and leadership, institutional design, and structure, intersectorality and capacity of the municipal government to generate health policies, such as the Municipal Policy on Food and Nutrition Security, addressing non-communicable diseases from the food, nutrition and rural situation through an eco-systemic and intersectoral approach.

CONCLUSION

The municipality is the appropriate setting for the planning of cross-sectoral strategies with clear municipal leadership in the governance framework.

Experiencias de promoción de la salud y gobernanza en el ámbito local de México: retos y limitaciones

Resumen

Dentro de la promoción de la salud, hablar de gobernanza y de los distintos actores sociales con quienes se establecen alianzas para mejorar la salud de la población, requiere un análisis de las características específicas del desarrollo socioeconómico y político en el que se encuentre la región o el país y fortalecer la participación ciudadana con la finalidad de generar mayores espacios de interacción entre los actores sociales comunitarios y conectar de manera más eficiente al Estado con las necesidades poblacionales propiciando una mejor toma de decisiones y desarrollando un mejor estilo de gobierno. En un país como México con altos índices de pobreza, desempleo, una creciente desigualdad y baja escolaridad ¿de qué manera impulsar la gobernanza?; ¿es posible impulsar procesos de gobernanza en situaciones de pobreza?; ¿es suficiente considerar las alianzas y las redes para fortalecer las salud y el desarrollo? El objetivo de este manuscrito es reflexionar sobre los retos y limitaciones que ofrece el contexto mexicano para impulsar la gobernanza, a partir de experiencias comunitarias en el espacio local y dentro del marco de la promoción de la salud. Desde nuestra experiencia, la gobernanza se ve limitada por el aumento de la pobreza en nuestro país y por la existencia de un sistema autoritario y con poder centralizado. Sin embargo, a través de la metodología de investigación-acción-participativa y educación popular, la propia población de estudio ha incrementado las acciones de abogacía y gestión de recursos para su propio desarrollo. Se reconoce la necesidad de abrir espacios de reflexión y discusión acerca de los alcances, logros, retos y limitaciones de la promoción de la salud y la gobernanza en los distintos contextos dentro de los países en vías de desarrollo.

Popular education for health promotion and community empowerment: a review of the literature

While there is now general agreement that the most effective way to promote health and decrease health inequities is by creating more just economic, social and political conditions, there is much less agreement about concrete ways in which public health practitioners can work with communities to address inequities such as poverty, racism and powerlessness. Practical strategies are desperately needed. Popular education, also known as Freirian and empowerment education, has been used successfully to create more equitable conditions around the world for >50 years. Its use to improve health has been documented in the public health literature since the early 1980s. Nonetheless, it remains largely unknown and its potential unrealized in mainstream public health circles in the industrialized world. In order to explore the potential of popular education as a tool to address inequities and improve health, a systematic review of the peer-reviewed international literature was conducted. Findings revealed that popular education is an effective method for enhancing empowerment and improving health. However, the existing literature does not provide empirical evidence that popular education is more effective than traditional education at increasing health knowledge and empowerment and changing health behavior. In order to fully understand the potential of popular education as a tool to eliminate health inequities and to advocate effectively for its use, further studies are needed that utilize mixed methods, participatory approaches and experimental or quasi-experimental designs.