PASB’s strategic and technical support reinforced countries’ capacity to address the determinants, contributing to achievements, such as the following:

1. Scalable approaches to addressing the determinants of health forged ahead. PASB made significant progress in adapting and implementing the operational framework for monitoring social determinants of health and related policies, with a focus on generating information systems that support decision-making and intersectoral accountability. These efforts resulted in demonstrable uptake at territorial and national levels across multiple countries. For example, Costa Rica implemented its determinants strategy using a territorial approach, with a focus on the Brunca region, strengthening intersectoral action to address the determinants at the local level. 

2. Territorial strategies were implemented in 23 municipalities (over 1.5 million population) and three capital cities (over 20 million population) in Chile, Colombia, Costa Rica, Ecuador, Mexico, and Peru. Beyond PASB’s direct technical cooperation, this expansion was made possible through the Movement of Healthy Municipalities, Cities and Communities (see outcome 19).

3. Twenty-three national health programs across Brazil, Chile, Colombia, Panama, Peru, Trinidad and Tobago, and the Bolivarian Republic of Venezuela were assessed using a standardized tool to assess their design for achieving health for all. In Chile, for example, this resulted in the redesign of five programs and the implementation of actions in 12 municipalities, with a clear pathway for future scaling.

4. Over 450,000 people gained access to clean household energy for cooking, and tools applied in 25 cities guided actions that improved air quality and active mobility systems for more than 80 million people. Air quality surveillance regulations, norms, and epidemiological capacities were strengthened in 12 countries (Bahamas, Belize, Bolivia [Plurinational State of], Colombia, Cuba, Dominican Republic, El Salvador, Mexico, Nicaragua, Panama, Peru, and Uruguay). Health national adaptation plans that included vulnerability assessments were developed in five countries (Barbados, Dominican Republic, Guyana, Jamaica, and Saint Vincent and the Grenadines).

5. Expanded access to safely managed water and sanitation services enabled 22 million additional people to benefit from improved WASH conditions, while 1.37 million fewer people practiced open defecation between 2023 and 2024. The development and implementation of 35 water and sanitation safety plans, supported through PASB’s technical cooperation, benefited 8 million people by enhancing resilience to environmental risks. In addition, 16 national and 46 local health care waste management plans were developed, reinforcing safe practices in health facilities and reducing environmental contamination. 

Despite these notable achievements, the following challenges persisted: 

1. Fragmented approaches across technical areas reduced efficiency and coherence, weakening the translation of normative guidance into system-wide practice and highlighting the need for better integration of the determinants.

2. Adoption of intersectoral approaches was largely incremental and concentrated in niche or project-based initiatives, rather than embedded as institutionalized country capacity.

PAHO’s contribution in this area strengthened health promotion and intersectoral action, including Health in All Policies approaches, contributing to achievements, such as the following:

1. Fourteen countries established health promotion policies or frameworks, and seven countries (Belize, Bolivia [Plurinational State of], Canada, Costa Rica, Ecuador, Grenada and Honduras) incorporated health promotion into health or development plans. Building on subregional dialogue and large-scale capacity-building (over 119 000 participants in a Virtual campus for Public Health course), PASB supported institutionalization of health promotion during the biennium, in line with the strategy and plan of action on health promotion.

2. Engagement with local governments was scaled through the Movement of Healthy Municipalities, Cities and Communities, involving more than 4,000 local authorities across 17 countries, 15 networks, 20 ministries of health, and the addition of 400 cities in 2025 following a formal agreement with Mercociudades. For example, Cuba expanded the movement to 94 municipalities, strengthening intersectoral governance and local action on health and well-being.

3. A regional framework for monitoring intersectoral action and Health in All Policies in the Americas advanced, with indicators agreed with 10 countries. Regional collaboration was consolidated through the formalization of a network on intersectoral action, bringing together 47 institutions from 13 countries and strengthening cross‑country knowledge exchange. 

However, challenges limited the depth and consistency of implementation:

1. While the need has been acknowledged to engage sectors beyond health – such as education, housing, labor, social protection, environment, and finance – such engagement tended to be limited to seeking ad hoc support for health-led initiatives as opposed to genuine intersectoral integration. 

2. In many contexts, health promotion remains narrowly focused on individual and behavioral interventions, such as campaigns, limiting attention to advancing public policy, intersectoral governance, community participation, and action on the determinants.

PAHO focused on strengthening capacity to address disparities related to the cross-cutting themes, contributing to achievements such as the following:

1. Nine countries (Colombia, Costa Rica, Cuba, Ecuador, Honduras, Mexico, Nicaragua, Panama, and Peru) improved capacities to monitor and reduce health gaps through improved availability, quality, and use of disaggregated health data, supported by analytical methods to assess the impact of policies and interventions, including telehealth services. A health for all perspective was integrated into surveillance tools and analytical guidance addressing the determinants, including environmental challenges such as air pollution, strengthening evidence‑based decision‑making to reduce avoidable gaps.

2. Multiple countries advanced intercultural approaches to health challenges, with support from PASB through digital products, technical guidance, regional consultations with Indigenous youth, and targeted training. In Peru, for example, knowledge dialogues were embedded in health policy and operationalized through service delivery models such as at Atalaya Hospital, which improved access and quality of care for Indigenous populations. Paraguay also implemented an intercultural model of care, expanding access to maternal, neonatal, and family health services for Indigenous, rural, and border populations. 

3. The Region made progress in addressing health in contexts of deprivation of liberty, supported by PAHO’s normative guidance (including guidelines for responding to tuberculosis, HIV, STIs, and viral hepatitis) and promotion of joint planning between health and justice sectors. In Colombia, a specialized tool was implemented at selected detention centers, including facilities for women, men, and minors, to assess and respond to health needs. 

However, challenges affected the effective application of cross-cutting themes, such as the following:

1. Siloed approaches to addressing the topics under this outcome reduced efficiency and impact, which the integrated approach to advancing health for all in the SP26-31 aims to address. 

2. Political and contextual factors affected the explicit adoption of approaches related to disparities in some contexts.