Abstract
Background: Social Determinants of Health (SDH) are factors that impact on people's health and more vulnerable populations. SDH are categorized along axes of inequality: socio-economic status, gender, ethnicity, educational level, occupation or income, which result in fewer opportunities to be physically active or have poorer dietary habits. Developing projects that address the SDH involving community actors is necessary to create healthy environments, empower the population, minimize inequalities in health and favour the most vulnerable groups. In this sense, community-based participatory processes can broader health-in-all-policies strategy as integrates individuals and communities as active partners in improving the SDHs. The European Joint Action Health4EUkids aims to promote healthy lifestyles and prevent childhood obesity by transferring “Grünau Moves” Best Practice, which has proven to be effective in Leipzig, Germany.
Approach: The Basque Country region, in Spain, aligned with the Community care and empowerment strategy of Osakidetza Basque Health Service, is adapting and implementing “Grünau Moves“ practice through a community participatory process in a disadvantaged, low socio-economic level and social inequalities municipality.
Based on a collaborative and context-sensitive methodology including key social and health community stakeholders and general population, the project is strategically targeting the SDH structures and conditions from an equity and inclusive perspective. This process that prioritizes the most vulnerable population participation, embodies the principle of ‘knowledge for action’, guided by the next Core Focus Areas: (1) Understanding relationships – Health Network approach; (2) Participatory Needs Assessment and Health Assets Mapping; (3) Developing Strategies – Participatory Problem Solving and Intervention Planning; (4) Measuring Changes - Evaluation Plan; (5) Evaluating Effectiveness; (6) Ensuring Transferability (Obstacles and Facilitators); (7) Assessing Sustainability.
This structured co-design approach ensures the involvement of the community in all stages which enriches the process and fosters the sustainability and effectiveness of the actions deployed.
Results: The program, implemented in the Basque Country region, is focused on promoting participatory and collaborative work between key community actors, citizenship, political, technical, educational and health professionals from the municipality, to generate changes towards equity, inclusion and diversity in health and include the health in all policies integrating people's perspective. It fosters the creation of a community network involving different local actors, including citizens, to identify and prioritize actions in the local environment that will eventually impact the lifestyles of the child population and improve their well-being, together with the whole community. Social cohesion, empowerment and control of the process by the community enable a real impact on the health status of the population and their mental and physical well-being.
Implications: The benefits of community-based collaborative approaches to addressing childhood overweight and obesity facilitate the development of tailored projects adapted to each context integrating cultural, socioeconomic, and environmental factors influencing children’s health behaviours. It guarantees the engagement of all communities to empower individuals and families to have an active role in improving their neighbourhood, generating social cohesion, trust and new connections. Therefore, allows to take individuals ownership of their health, acquire new habits and promote sustainable and long-term changes in their living environment and communities.