Reaffirming Member States’ commitment to achieving SDG 3 with health equity: The Policy for Recovering Progress toward the Sustainable Development Goals with Equity through Action on the Social Determinants of Health and Intersectoral Work (Document CSP30/8) was adopted by the 30th Pan American Sanitary Conference in 2022. To accelerate progress toward SDG targets, PAHO collaborated with other United Nations agencies to implement the SDG 3 Global Action Plan initiative, which advanced in the Plurinational State of Bolivia, Chile, Colombia, Costa Rica, Dominican Republic, Mexico, and Nicaragua. For example, Colombia partnered with PAHO, the World Food Program, UNICEF, and UNFPA to address maternal and neonatal mortality rates among Indigenous communities by improving health care accessibility and incorporating culturally sensitive approaches. In Costa Rica, a community-led, intersectoral approach empowered local communities to tackle issues such as gender-based violence and mental health through targeted workshops and awareness-raising campaigns.

Addressing social determinants of health, equity, and vulnerability: There was significant progress in integrating the social determinants of health into policies and programs, such as the integration of social determinants of health and equity in health reform processes in Chile, Colombia, and Mexico, with a focus on primary health care and public health. In Mexico, the WHO Innov8 approach, which aims to ensure no one is left behind, was integrated into programs of the Mexican Social Security Institute.

Making high-level commitments regarding the health impacts of climate change: MERCOSUR health ministers signed a new strategy on climate change and health, and 12 countries established national health adaptation plans. Argentina enhanced climate-sensitive disease surveillance with a focus on conditions such as heat-related illnesses and dengue. Sixteen Caribbean countries made progress on strengthening their health systems to be resilient to climate change, with support from the European Union. These countries took actions to reduce greenhouse gas emissions in their health systems, establish early warning systems for the most affected populations, and implement sustainable policies and interventions in health, environment, transport, and energy systems. 

Addressing environmental health issues: PASB assessed 1800 health care facilities in eight countries (Argentina, Plurinational State of Bolivia, Guatemala, Honduras, Mexico, Panama, Paraguay, and Peru) for water, sanitation, and hygiene (WASH) services as well as clean electrification. WASH services were enhanced at four health care facilities in Honduras and seven in Peru. Direct investments and capacity-building efforts were made to improve management of wastes and hazardous chemicals. In an effort to eliminate open defecation, cost-effective sanitation technologies were deployed, benefiting 3.7 million people in rural communities in the Plurinational State of Bolivia, Colombia, Haiti, Honduras, and Peru. PAHO’s approach included the development and implementation, with resource mobilization, of climate-resilient water and sanitation safety plans in 110 cities, impacting 72 million individuals. Additionally, PASB provided training and guidance on minimizing mercury exposure from fish consumption and mining, targeting pregnant women, people in conditions of vulnerability, and people affected by gold mining in the Plurinational State of Bolivia and Peru. Over 2 million people in El Salvador, Panama, and Nicaragua have transitioned from polluting fuels to cleaner energies in households. Chile enhanced health regulations to reduce morbidity, mortality, and costs associated with poor indoor air quality.

Increasing capacities to prevent, detect, and monitor selected occupational diseases: The Secretariat of the Council of Ministers of Health of Central America and the Dominican Republic (SE‑COMISCA) approved in 2022 the Strategy for the Prevention, Mitigation and Control of Chronic Kidney Disease of Non-traditional Origin in Central America and the Dominican Republic, 2022–2025 (Resolution 04-2022), developed in collaboration with PAHO and other partners. PASB subsequently provided technical support to improve working conditions to prevent this disease, strengthen health surveillance and early detection, and ensure comprehensive care for people affected. Additionally, Brazil approved a new list of work-related diseases that includes occupational hazards and Chile developed a comprehensive and interactive occupational health surveillance system. PASB also worked to raise the visibility of precarious work and informality among domestic workers, in collaboration with the Latin American and Caribbean Confederation of Domestic Workers (CONLACTRAHO), and of living conditions for temporary migrant workers, in collaboration with the Central American Integration System.

Strengthening and expanding intersectoral work and civil society collaboration to address health equity: In November 2023, the Network on Intersectoral Work and Social Participation for Health Equity in the Americas (TIPSESA Network) was established. During 2023, a call went out to identify and collect national, subnational, and local experiences of intersectoral action that have contributed directly or indirectly to health equity in the Region. Of the 224 proposals received, 39 were selected and presented at the Conference on Intersectorality for Health Equity in the Americas, held in November 2023 in Cuba. In addition, evidence was developed on the role of civil society organizations during the COVID-19 pandemic, characterizing their repertoires of action, the barriers and facilitators affecting their work, their relationship with PASB, their work with local governments and agencies in their countries, and the weaknesses identified in pandemic responses at the local level.

Advancing health promotion in the Region: The biennium saw strides toward implementing the Strategy and Plan of Action on Health Promotion within the Context of the Sustainable Development Goals 2019–2030 (Document CD57/10). Paraguay launched a new national policy on health promotion, El Salvador approved a national policy on health promotion, and Costa Rica approved its institutional plan on health promotion for 2023–2027. COMISCA (Council of Ministers of Health of Central America and the Dominican Republic) approved the 2023–2025 Action Plan of the Health Promotion Strategy in the Context of the 2030 SDGs (Resolution 14-2022). Caribbean countries reaffirmed their commitment to health promotion and proposed further actions, three decades after the establishment of the Caribbean Charter for Health Promotion.

Taking action at local level: Mayors of local governments established a new governance structure to strengthen the Healthy Municipalities, Cities and Communities Movement of the Americas (HMCC), with PASB serving as the technical secretariat. The HMCC is a regional platform of over 3000 local governments, including cities, municipalities, cantons, communes, and communities. PASB plays a crucial role in supporting and coordinating the HMCC by providing technical guidance and expertise to local governments on health promotion and well-being, as well as advocating for a Health in All Policies approach. During the VI Meeting of HMCC, held in November 2023 in Chile, regional criteria were adopted to strengthen public policies, plans, and programs aimed at improving the health and well-being of the populations served by local governments. These criteria were developed collectively through a consultative process, under the leadership and technical coordination of PAHO, to achieve harmonization with national, subnational, and local planning frameworks.

Promoting integration of equity, gender, ethnicity, and human rights: Practical tools, resources, and approaches developed by PAHO have been pivotal in driving action plans and strategies in this area. The knowledge dialogues methodology has been applied in over 10 countries and adopted by partners such as the Food and Agriculture Organization of the United Nations (FAO), Fund for the Development of Indigenous Peoples of Latin America and the Caribbean, and United Nations Educational, Scientific and Cultural Organization (UNESCO). In Ecuador, advances were achieved through knowledge dialogues around ancestral-traditional medicine and work with traditional midwives. The gender and intersectionality analysis methodology was also developed and applied in four countries (the Plurinational State of Bolivia, Colombia, Ecuador, and Haiti) to identify groups that face access barriers to health services. 

Improving equitable access to and coverage of COVID-19 vaccination, and strengthening essential health services: In Costa Rica, women leaders of Indigenous communities received capacity‑building to enable them to conduct workshops on vaccination, biopsychosocial recovery from the COVID-19 pandemic, and health promotion. The women also participated in developing work plans focused on health, gender, and equity, adapted to the characteristics and needs of each community. Approaches adopted in Argentina, Honduras, and Nicaragua targeted the barriers to access to the COVID-19 vaccine. In Ecuador, PASB worked to strengthen knowledge and risk management around health emergencies and disasters, collaborating with civil society organizations to implement a comprehensive, community-based action plan in the Achuar and Shuar Indigenous communities. The project helped maintain essential health services and raise awareness in these remote communities about future public health emergencies. 

Building technical capacity for gender equity and human rights: Over 25 000 people from 33 countries in the Region have benefited from open-access, self-learning virtual courses, made available through PAHO’s Virtual Campus, that enhance understanding of how gender operates as a determinant of health. The courses also cover the theoretical and practical framework on international human rights law standards applicable to the right to health and related rights.

Securing high-level commitment on Indigenous issues: Together with the Organization of American States (OAS), PASB co-organized the First Inter-American Meeting on the Implementation of the American Declaration of the Rights of Indigenous Peoples, held in Guatemala. In addition, PASB collaborated with WHO on the resolution on Indigenous health put forward by Brazil and approved by the 76th World Health Assembly in May 2023.