Health promotion: challenges revealed in successful practices

Silva, Kênia Lara; Sena, Roseni Rosângela de; Belga, Stephanie Marques Moura Franco; Silva, Paloma Morais; Rodrigues, Andreza Trevenzoli

doi:10.1590/S0034-8910.2014048004596

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Original Articles • Rev. Saúde Pública 48 (1) • Feb 2014 • https://doi.org/10.1590/S0034-8910.2014048004596 copy

Health promotion: challenges revealed in successful practices

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

: To examine successful practices of health promotion in health, education, culture, welfare and sport, leisure, identifying the elements of success and challenges in the field.

METHODS

: A qualitative study with data obtained from in-depth analysis that included participant observation, interviews with managers, coordinators, professionals and participants from 29 practices reported as successful for promoting health in six municipalities of the metropolitan region of Belo Horizonte, MG, Southeastern Brazil, in 2011. The variables of the study were concept, dimension, dissemination and ease of access, identified in practices guided by content analysis.

RESULTS

: The results indicate a conceptual and methodological uncertainty about health promotion as evidenced by conflicting objects and contradictory purposes. The practices differ in size, coverage and ease of access, determined by inter-sector coordination and political and financial investment.

CONCLUSIONS

: We identified challenges to health promotion focusing on vulnerable populations, limits to financing and intersectoral partnerships.

Health Promotion; Health Public Policy; Health Education; Social Assistance; Motor Activity; Culture; Qualitative Research

Practices	Characterization	Elements of success	Challenges
P1SM1	Oriental exercise in public spaces of the city with predominant involvement of the elderly population. About 300 beneficiaries in different locations of the city.	Capillarity, low cost to implement.	Focus on the use of drugs and physical and psychological symptoms.
P2SM1	Talks and educational groups working cognitive perception, emotion and diet, involving different age groups. Organized in groups of approximately 10 patients with chronic diseases, varied occurrence in local health units of the municipality.	Federal financing	Biomedical design and few mechanisms for intersectorial coordination and monitoring and evaluation.
P3SM1	Physical activity and aerobic and anaerobic exercises for young people and adults in 48 gyms around the city	Capillarity and recognition of the population, federal funding.	No monitoring or evaluation mechanisms.
P4SM2	Physical activity in 26 public spaces in the city with aerobic and anaerobic exercises with audience predominantly comprised of seniors.	Based on the healthy city perspective; capillarity, universal access and recognition by the population.	Little evidence of intersectorial cooperation or monitoring or evaluation mechanisms.
P5SM3	Complementary and integrative practices such as acupuncture, auriculotherapy, homeopathy, herbal medicine, tai chi chuan, and others, performed in two centers in the city serving a population of approximately 3,500 individuals/year.	Diversity of activities, capillarity; municipal investment.	Scarce financing.
P6SM3	Therapeutic workshops in music, theater and crafts favoring psychosocial rehabilitation of those with mental health problems in a Reference Center for Social Assistance.	Potential for sustainability through income generation; has personal initiative to reintegrate socially.	No government financing; small scale.
P7SM4	Complementary and integrative practices, such as homeopathy, acupuncture, yoga, dance therapy and others in a core municipality serving a population of approximately 200 individuals/year.	Municipal investment.	No potential for autonomy or accountability.
P1EM1	Monthly workshops to integrate families and schools in Social Care Centers for approximately 6,000 recipients of the Bolsa Família and Família-Escola Programs.	Municipal financing.	Restricted to a specific population group.
P2EM1	Workshops in all municipal schools covering topics such as sexual and gender diversity, citizenship and health aspects along with overall comprehensive development.	Capillarity and federal financing	No evidence of intersectorial cooperation or monitoring or evaluation mechanisms.
P3EM2	Workshops covering gender and sexual diversity inclusion in 14 in the municipality’s high schools.	Training of peer educators could attain capillarity.	Small scale.
P4EM4	Providing balanced meal in 23 municipal schools.	Federal financing and municipal support; large scale.	Few intersectorial cooperation or monitoring or evaluation mechanisms.
P5EM5	Clinical and pedagogical appointments promoting inclusive education though caring for children with special needs in a municipal center.	Municipal initiative and investment, together with federal financing.	Biomedical conception; few intersectorial cooperation or monitoring or evaluation mechanisms.
P6EM6	Home visits to clear up doubts and help children with homework. Especially those who are socially vulnerable.	Based on personal initiative of a teacher in the municipality.	Restricted to a specific group.
P1ASM1	Games workshops and theatre working on healthy eating with primary school children in 54 schools in different areas of the city, especially those which are more vulnerable.	Municipal policy guarantees development of this practice.	Limited to groups deemed vulnerable.
P2ASM1	Monthly meetings of groups of 15 to discuss issues related to family organization and structure for recipients of Bolsa Família Program.	Priority investment area for social policies.	Little evidence of intersectorial cooperation or monitoring or evaluation mechanisms.
P3ASM2	Providing low cost balanced meat to families with food insecurity. Serving around 600 people 5 days a week.	Federal financing.	Assistance limited to a specific group. No mechanisms to stimulate autonomy or social participation were observed.
P4ASM2	Community vegetable gardens involving 21 units in the municipality including schools, churches and health care services.	High capillarity. Federal financing.	No evidence of monitoring or evaluation mechanisms.
P5ASM2	Meetings with 64 families resettled due to the Aceleração do Crescimento Program.	Priority investment area for social policies.	Limited amplitude.
P6ASM2	Action of 30 women living in vulnerable regions, identifying risk situations and intervening with individuals and communities, reducing situations of violence especially aimed at young people.	Municipal investment regarding political induction.	Restricted to a specific, vulnerable group of the population.
P7ASM2	Transport for 120 special needs children in wheelchairs to health care and education services.	Municipal investment.	Restricted to a specific, vulnerable group of the population.
P8ASM2	Educational workshops covering topics related to ageing and integration in a municipal center for the elderly.	Priority investment area for social policies.	Small scale and no evidence of monitoring or evaluation mechanisms.
P9ASM4	Physical activity and crafts, singing workshops and leisure afternoons with bingo and dancing for the elderly population in a municipal center for the elderly.	Capillarity and municipal investment.	Scarce financing.
P10ASM6	Activities of dance and music from different cultures, with approximately 160 children and adolescents in situations of vulnerability caused by child labor.	Priority investment area for social policies.	Small scale and no evidence of intersectorial cooperation mechanisms.
P1LM2	Sports and competition in three sports courts for municipal school age children, in particular those with social risk.	Municipal investment.	No evidence of intersectorial cooperation or monitoring or evaluation mechanisms.
P2LM2	Sports competition between public and private schools in the city with about 3,500 participants in activities that take place annually.	Social mobilization and municipal investment.	Little evidence of intersectorial cooperation or monitoring or evaluation mechanisms.
P3LM4	Physical activities and arts and music workshops with children and adolescents at social risk.	Municipal investment.	Scarce financing.
P4LM4	Work activities developed through physical activity in the workplace of a company.	Municipal investment.	Based on the biomedical concept; restricted to a specific group.
P1CM4	Physical activities, and talks with information on pregnancy and baby care for groups of six pregnant women in a highly vulnerable area of the municipality.	Based on an NGO initiative	No government financing; small scale.
P2CM6	Annual event for socializing with traditional recipes of the county and with the participation of approximately 1,500 people.	Social mobilization, enhancement of autonomy and sense of belonging; municipal investment and supporting local culture.	Scarce financing.

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[1] Correspondence
: Kênia Lara Silva. Escola de Enfermagem – Universidade Federal de Minas Gerais. Av. Alfredo Balena, 190 Sala 508 Santa Efigênia. 30130-100 Belo Horizonte, MG, Brasil. E-mail: kenialara17@gmail.com