Public health policies as guides for local public policies: the experience of Sobral-Ceará,Brazil

The accelerated urbanisation process that Brazil has gone through in the last 50 years has given rise to daunting challenges for public managers, especially in terms of local public policy management for the building of “healthy cities”. In Sobral, a municipality of 173,000 inhabitants in Ceará in the North-eastern region of Brazil, a number of municipal policies were initiated beginning in 1997, many in partnership with the federal and state governments. They were inspired by the vision of a healthy and equitable city and were marked by strategic planning and the implementation of intersectoral projects. This article lays out some of the actions and their results, including an increase in the public supply of drinking water from 65% to 97% of households; an increase in sewage networks from 7% to 65%; an increase in public refuse collection from 42% to 90%; the expansion of green areas; the construction of nine kilometres of bicycle paths; the universalisation of integral health care through the Family Health Strategy through a network with specialised out-patient and hospital services; and a 148% increase in the number of children enrolled in primary school. These initiatives also resulted in the improvement of quality of life indicators, including a reduction in infant mortality from 61.4 to 19.0 per thousand live births, a drop in the mortality rate from traffic accidents from 33.40 per 100,000 inhabitants in 2001 to 15.25 in 2003; and a jump in literacy rates among children in the first cycle of primary school from 40 to 90.7%. In the present article, the authors describe some of the successful strategies and projects initiated between 1997 and 2003, and discuss how this experience could be reproduced in other communities across Brazil and around the world.