Maria Isabel Loureiro

How should we define health

The WHO definition of health as complete wellbeing is no longer fit for purpose given the rise of chronic disease. Machteld Huber and colleagues propose changing the emphasis towards the ability to adapt and self manage in the face of social, physical, and emotional challenges

Priorities for mental health promotion during pregnancy and infancy in primary health care

The perinatal period (shortly before and after birth) is a particularly significant stage, providing a sound base for healthy development. Primary health care should accompany the individual through the entire life cycle, and mental health problems constitute a public health threat that calls for the development of mental health promotion initiatives in primary health care. Responding, in 2004 our team initiated an action research project with the aim of reorganising primary health care during pregnancy and the first year of life. The aim is to enable health professionals to support families in the transition to parenthood, thereby promoting childrens mental health. In order to plan this reorganisation, we developed a two-step decision-making process: 1. assessment of antenatal health care; 2. joint reflection concerning the priorities for change. The study goal was to assess the particular characteristics and needs of families during the perinatal period as well as the kind of care they were actually receiving. We designed a cross-sectional quantitative—qualitative study that collected data from users and health professionals using questionnaires and semi-structured interviews. The reflection step took place during a workshop that aimed to analyse the results and discuss priorities. The study confirmed the need to search for mental health problems during pregnancy, particularly to prevent a disturbed mother/child bonding process, and the importance of emphasising issues such as communication, information provision and the adequate availability of health professionals for antenatal care. The findings led to the following conclusions: 1. risk and needs assessment regarding mental health and options for family support should be included in the protocols of antenatal care; 2. primary health care professionals should be enabled to undertake diagnostic work and problem solving related to mental health; 3. collaboration between different levels of health care and between health sector and community resources should be increased. The highly participative decision-making process used led to a selection of priorities and strategies that was meaningful to users and health professionals and should contribute to the implementation and sustainability of changes for mental health promotion. (Global Health Promotion, 2009; 1 (1): pp. 29—38)

Engaging municipalities in community capacity building for childhood obesity control in urban settings

BACKGROUND Reducing rates of child obesity requires an approach that transcends the medicalization of overweight. Family practice doctors and public health professionals need to work with other sectors to establish comprehensive approaches to obesity reduction. OBJECTIVES This study compares the approaches of three cities with different health and political systems (Lisbon, London and New York City) to promoting effective action to decrease child obesity. METHODS Using a comparative case study approach, participant observers in three intersectoral municipal collaborative on child obesity describe their challenges and accomplishments. RESULTS Municipal governments made child obesity a policy priority and coordinate efforts in different sectors. Public health provided relevant information on population characteristics and scientific evidence for decision-making, family practice monitored childrens growth and assisted families to adopt healthy behaviors. These sectors, together with university-based researchers, also played an advocacy role, addressing inequalities, alerting the public and policy makers about damaging products or risky situations, and regulating private interests that threaten well-being, e.g., the food and beverage industry that promotes unhealthy products. Local, national and global networks of health providers, municipal agencies and researchers have helped to diagnose problems, coordinate action across sectors and levels, share and evaluate successes and failures, translate evidence into practice and promote social cohesion. CONCLUSIONS These cities have developed common approaches and face similar challenges in reducing high rates of child obesity, suggesting that it may be possible for cities in different parts of the world to learn from each other and thus accelerate progress.