5.3. Building local strategies for addressing the social determinants of health equity

Theory of Change training in Colombia: Training on the theory of change for teams involved in SIMASHE at the municipal, regional and national levels in Colombia aimed to facilitate participatory diagnostic and decision-making processes to address the social determinants of health equity in local areas. More than 20 professionals were trained to support the ongoing process in the three SIMASHE municipalities in three country departments. These professional teams will be strategic partners to scale up the theory of change methodology with other country municipalities and departments, to identify, prioritize and design relevant local-level interventions to address the social determinants of health equity.

Training-of-trainers for planning workshop in Costa Rica A training-of-trainers workshop on the theory of change was developed to strengthen local capacity to address the social determinants of health. Participants from the municipalities of Corredores, Golfito, Osa and Coto Brus attended, all active members of Territorial Planning Committees. They will support and replicate Theory of Change workshops in their communities, ensuring follow-up on action plans. 

Developing a culturally relevant planning exercise in Totoró, Colombia: Dialogues integrating the perspectives of different cultures were held during the development of the theory of change for improving health equity in Totoró. Representatives from various Indigenous groups, subsistence farmers and residents of the local administration came together to analyze the issue of access to quality water across different geographic areas of the municipality, bringing their different perspectives, priorities and worldviews. The workshop highlighted the need to imagine in detail the differential impact of the problem on different groups, as well as the importance of implementing consensual interventions adapted to communities’ diverse needs and visions.

Catalyzing Multi-sector Action on Social Determinants of Health in Tolosa, Philippines: Recognizing the complexity of health inequities and the importance of addressing noncommunicable diseases through a social determinants of health equity approach, regional, provincial and municipal stakeholders were engaged to build multisectoral partnerships beyond the health sector. By bringing together government agencies, community organizations and non-health sectors, participants gained a shared understanding of the root causes of health inequities and the value of a multistakeholder approach in addressing interconnected determinants, such as education, housing and employment. A key outcome was a joint multisectoral commitment to co-develop a unified framework for addressing the SDH in Tolosa, laying the groundwork for long-term, equity-driven action and aligning local efforts with the development of support structures at the regional and provincial levels. 

Using the WHO Urban Health Assessment and Response Capacities Kit to build food safety in Suava, Fiji: The Suva City Council piloted the resource kit to assess and plan actions for creating a food-safe city. The assessment process helped identify key systems and governance levels involved in food safety, as well as resource needs for monitoring and regulating street-food vendors. It also fostered strong engagement from stakeholders, including city inspectors and vendors.

Using the WHO Urban Health Assessment and Response Capacities Kit to leverage culture and creativity in London, United Kingdom: The Greater London Authority applied the Urban Health Capacities Resource Kit to support its strategy of using culture and creativity to improve health. The assessment identified strong capacities in strategy development, but highlighted challenges such as limited data systems, difficulties in cross-sector coordination, and a lack of sustainable funding. An action plan was developed to address these gaps, including proposals for staff training, improved data use and stakeholder engagement.

Using the WHO Urban Health Assessment and Response Capacities Kit to build a healthy community in Gwangju Dong-Gu, Republic of Korea: The Health Policy Division and the Urban Agriculture Department of the Gwangju Dong-Gu District Office used the resource kit to assess capacities for building a healthy community through healthy food, in preparation for their 2025 Food Plan. The participatory process allowed for the identification of 25 key capacities, highlighted existing community structures and prioritized actions, while promoting dialogue on barriers and synergies in district policies and services.

Using the WHO Urban Health Assessment and Response Capacities Kit to prevent falls in older people in Utrecht, the Netherlands: The Public Health and Fall Prevention Teams used the resource kit to assess local capacities for preventing falls among older people. The process revealed that capacities to implement a city-wide intervention were already in place, and helped the team reflect on both individual and systemic factors influencing falls among elderly people. It also highlighted the importance of building cross-sector collaboration and identifying relevant stakeholders over time. Based on the assessment, the city is now implementing a four-year plan targeting fall risk assessments and preventive exercise programmes for older adults, in coordination with local partners and services.