Health, according to the World Health Organization (WHO, 1948), is defined as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. This broad view of health is complemented by the approach of the 2022-2030 Health Plan, which sees it as a dynamic and adaptive concept. Rather than being a static state, health involves the capacity of individuals and communities to face adverse circumstances, manage physical, emotional, social, and ethical challenges, and maintain functional balance in their environment.

According to the perspective of Huber et al. (2011), this resilient approach acknowledges that Health is not an immutable state, but a continuous process of interaction and adaptation between individuals and their social and environmental context. This understanding emphasizes the importance of developing skills and capabilities that enable people to face the challenges they encounter, fostering their autonomy and active participation in improving their quality of life.

In this sense, as Jadad and Bimbela (2021) state, “health is the ability of individuals and communities to adapt and manage the physical, emotional, social, spiritual, and ethical challenges that arise in life.” This definition is inclusive and realistic, aligning with current public health challenges, such as chronic diseases and the effects of climate change. It also promotes a comprehensive approach that combines prevention, adaptation, and collective action, key to addressing health issues in a changing world.

In summary, health is not merely the absence of disease, but a vital capacity that allows individuals and communities to thrive and actively participate in the construction of their well-being, adjusting to available circumstances and resources to improve their quality of life.

“Any factor (or resource) that enhances the capacity of individuals, groups, communities, populations, social systems, and institutions to maintain and sustain health and well-being, and that helps reduce health inequalities” (Morgan and Ziglio, 2007).

A set of personal, social, health, economic, and environmental factors that condition the health status of individuals and the populations in which they live.

Social determinants of health are the circumstances in which people are born, grow, live, work, and age, including the healthcare system.

These circumstances are the result of the unequal and sometimes unjust distribution of money, power, and resources at the global, national, and local levels, which in turn depend on the policies adopted.

Health equity “means that everyone should have a fair opportunity to achieve their maximum health potential. More pragmatically, it means that no one should be disadvantaged from achieving this potential to the extent possible. Equity refers to creating equal opportunities for health, as well as reducing health disparities to the lowest possible level.”

It means that people's needs guide the distribution of well-being opportunities, synonymous with fairness.

The WHO Global Strategy for Health for All has as its main goal to achieve greater health equity between populations and within them, as well as between countries. The lack of equity arises as a result of differences in opportunities stemming from macroeconomic, social, and health policies, for example, due to unequal access to healthcare services, adequate nutrition, adequate housing... The lack of equity in life opportunities would lead to health inequalities.

A process through which various community agents participate in the analysis, design, implementation, and evaluation of community processes that address their health needs, establishing shared goals and acting cooperatively. It was defined at the Alma-Ata Conference as the process through which individuals and families take responsibility for their own health and well-being, as well as that of the community, enhancing their capacity to contribute to their own development and that of the community. This process allows them to better understand their own situation and find incentives to solve common problems. It enables them to be agents of their own development, rather than passive beneficiaries.

The term community participation refers to the collective awareness of the entire community regarding the factors hindering growth, through critical reflection and the promotion of associative and organizational forms that facilitate the common good. The community would organize itself by assuming obligations and responsibilities while maintaining communication channels with authorities and the population. In 1981, the United Nations defined it as “the creation of accessible opportunities for all members of a community and for society as a whole, to actively contribute to the development process, influence it, and share equitably in the fruits of that development.”

Actions developed within the political sphere and from an intersectoral perspective, taking into account the health implications for individuals and populations arising from political decisions in areas such as urban planning, transportation, leisure and free time, industry, healthcare, trade, and more. These actions aim to generate synergies and avoid negative impacts on health, with the objective of improving the health of the population and developing a perspective of equity.

Health promotion is an integral social and political process that not only involves actions aimed at strengthening individuals' skills and capacities, but also actions aimed at changing the social, environmental, and economic determinants of health, in order to optimize their positive impact on both public and personal health. Health promotion is the process that enables individuals and communities to increase control over the determinants of health, thereby improving their health.

The Ottawa Charter identifies three basic strategies for health promotion:

• Promoting health to create the essential conditions for health, as mentioned earlier
• Enabling all individuals to achieve their maximum health potential
• Mediating between different interests in society to achieve health

The Ottawa Charter also identified five priority areas for action:

1. Developing healthy public policies
2. Creating supportive environments for health
3. Strengthening community action for health
4. Developing personal skills
5. Reorienting health services

These areas of action continue to be of vital importance in health promotion, and the underlying concepts have continued to evolve. Some of these actions, such as reorienting health services and community action for health, remain relevant but are represented with updated definitions. Others remain in the main body of the glossary, but have evolved into different terms. For example, the concept of healthy public policy remains valid on its own, but is now included within the contemporary concept of Health in All Policies. Similarly, the development of personal skills is incorporated into the definitions of health skills and health literacy.

Health Promotion Action Strategies:

• Action Area 1: Development of public health policies that are cross-sectoral.
• Action Area 2: Personal skills/health education.
• Action Area 3: Supportive environments for health.
• Action Area 4: Community participation in health.
• Action Area 5: Reorienting health services

Interrelationship of the Concepts Worked

The “health” of the people living in this neighborhood is influenced by the living and working conditions, which we have defined as the “social determinants of health.” The “participation” or involvement of the community (population, professionals, and political representatives) is essential to promote “health.”

These living and working conditions are not the same for everyone. There are unjust and avoidable differences that can be addressed by incorporating “equity” into all the actions proposed in the neighborhood to improve health and well-being

These actions are not only from health services. All the policies developed to address the determinants are also health policies.

Thus, health should be part of all policies that influence the neighborhood: urban planning, environmental, educational, food, sports policies, etc. This is what we call “health in all policies.”

When we look at our neighborhood with the “glasses” of the social determinants of health, we realize how important it is to work from the environments. The challenge is to build environments (urban, educational, work, etc.) in our neighborhood that facilitate decision-making in favor of health.

“Health assets” help us identify which resources in the neighborhood are already generating health and well-being. Creating a map of assets in a participatory way and connecting and energizing these identified assets helps make our neighborhood more salutogenic.

Healthy policies, even those that aim to address the more structural determinants, can rely on the connection and energization of the assets in the map.

Overweight and obesity in the people living in this neighborhood are influenced by the living and working conditions, by the social determinants of health. The participation of the community (population, professionals, and political representatives) is essential to promote health and address health issues such as obesity.

These living and working conditions are not the same for everyone. There are unjust and avoidable differences related to obesity that can be addressed by incorporating equity into all actions proposed to address obesity and generate health.

These actions are not only from health services. All the policies developed to address the determinants are also health policies that can be directed towards addressing overweight and obesity.

Thus, health should be part of all policies that influence the neighborhood: urban planning, environmental, educational, food, sports policies, etc. This is what we call “health in all policies” to address overweight and obesity.

When we analyze overweight and obesity in our neighborhood with the “glasses” of the social determinants of health, we realize how important it is to work from the environments. The challenge is to build environments (urban, educational, work, etc.) in our neighborhood that facilitate decision-making in favor of health or, in other words, to transform obesogenic environments into salutogenic environments.

Health assets help us identify which resources in these neighborhood environments are already generating health and well-being. The creation of an asset map in a participatory way and the connection and energization of these identified assets contribute to making our neighborhood more salutogenic.

Healthy policies, even those that aim to act on the more structural determinants, can rely on the connection and energization of the assets in the map and reduce overweight and obesity in the medium and long term, increasing equity in health.

Health promotion is a process that empowers individuals to take control of their well-being by addressing the social determinants of health. In this context, community participation from the three main stakeholders (citizens, professionals, and political representatives) is key to creating effective strategies that improve quality of life, always with an equity approach.

The image illustrates how social determinants are placed at the center of the actions required to create healthier environments. These actions are articulated through health promotion strategies aimed at integrating Health in All Policies. This means that all sectors influencing the neighborhood, such as urban planning, education, food, or the environment, must align to promote health.

The health promotion strategies reflected are:

1. Community Participation: Essential to empower the population and generate active involvement.
2. Training and Skill Development: Fundamental to fostering health education.
3. Connection and Mobilization of Community Assets: Identifying and enhancing existing resources that are already generating well-being.
4. Creation of Healthy Environments: Key to facilitating health-promoting decisions.

The goal is to transform the neighborhood into a salutogenic environment, a space where the easiest option for individuals is to adopt healthy behaviors. This approach does not focus on deficits or diseases, but on the potential of the neighborhood and its community to generate health, even when addressing issues like overweight and obesity.

The key term in this process is “salutogenic environments” because it reflects the positive and transformative vision of a neighborhood where structural policies, community participation, and the use of assets work together to sustainably promote health.