ISSN-L: 0798-1015   •   eISSN: 2739-0071 (En línea)

Vol. 46 (Nº 04) Año 2025. Art. 29

Recibido/Received: 06/05/2025 • Aprobado/Approuved: 15/07/2025 • Publicado/Published: 30/07/2025
DOI: 10.48082/espacios-a25v46n04p29

Desafíos estructurales en la eficacia de las políticas de promoción de la salud: una revisión de literatura

Structural challenges in the effectiveness of health promotion policies: a literature review

SAMAME-AGUIRRE, Giuliana1

Resumen
Este estudio revisa 38 artículos (2021-2024) sobre políticas de promoción de la salud, identificando los principales desafíos que afectan la eficacia de las políticas de promoción de la salud, a partir de una revisión de literatura reciente. Se analiza cómo factores estructurales, políticos, socioeconómicos y culturales limitan su implementación efectiva. El estudio resalta la necesidad de adaptar las políticas a contextos específicos, promoviendo enfoques contextualizados e intersectoriales que fortalezcan la equidad, sostenibilidad y pertinencia de las intervenciones sanitarias.
Palabras clave: Promoción de la salud, gobernanza participativa en salud, políticas públicas en salud.

Abstract
This study reviews 38 articles (2021–2024) on health promotion policies, identifying the main challenges that hinder their effectiveness. It examines how structural, political, socioeconomic, and cultural factors constrain policy implementation in diverse contexts. The findings underscore the need to adapt health promotion policies to specific national realities through contextualized and intersectoral approaches. Such strategies are essential to enhance equity, sustainability, and the relevance of public health interventions.
Keywords: Health promotion, participatory health governance, and public health policies.

ARTÍCULO COMPLETO/FULL ARTICLE

Referencias

Aldana-Parra, F., Olaya, G., & Fewtrell, M. (2020). Effectiveness of a new approach for exclusive breastfeeding counselling on breastfeeding prevalence, infant growth velocity and postpartum weight loss in overweight or obese women: Protocol for a randomized controlled trial. International Breastfeeding Journal, 15(1). doi:10.1186/s13006-019-0249-2

Alto Comisionado de las Naciones Unidas para los Refugiados (ACNUR). (2022). Directrices estratégicas regionales de ACNUR en las Américas sobre salud pública 2022-2025. https://www.refworld.org/es/pol/posicion/acnur/2022/es/134675​

Ayouni, I., Maatoug, J., Dhouib, W. et al. Effective public health measures to mitigate the spread of COVID-19: a systematic review. BMC Public Health 21, 1015 (2021). https://doi.org/10.1186/s12889-021-11111-1

Bakalár, P., Hnidková, L., Ružbarská, B., Ružbarský, P., Slančová, T. K., Kopčáková, J., … Gába, A. (2024). First report card on physical activity for children and adolescents in Slovakia: a comprehensive analysis, international comparison, and identification of surveillance gaps. Archives of Public Health, 82(1). doi:10.1186/s13690-024-01241-4

Barboza-Solís, C., Sáenz-Bonilla, J. P., Fantin, R., Gómez-Duarte, I., & Rojas-Araya, K. (2020). Theoretical implications for the analysis of social health inequalities: A discussion. Odovtos - International Journal of Dental Sciences, 22(1), 11–21. doi:10.15517/IJDS.2020.39097

Bhandari, D., Bi, P., Sherchand, J. B., Dhimal, M., & Hanson-Easey, S. (2020). Climate change and infectious disease research in Nepal: Are the available prerequisites supportive enough to researchers? Acta Tropica, 204. doi:10.1016/j.actatropica.2020.105337

Brakefield, W. S., Ammar, N., Olusanya, O. A., & Shaban-Nejad, A. (2021). An urban population health observatory system to support COVID-19 pandemic preparedness, response, and management: Design and development study. JMIR Public Health and Surveillance, 7(6). doi:10.2196/28269

Buheji, M., Alderazi, A., Ahmed, D., Bragazzi, N. L., Jahrami, H., Hamadeh, R. R., & Bahammam, A. S. (2022). The association between the initial outcomes of COVID-19 and the human development index: An ecological study. Human Systems Management, 41(2), 303–313. doi:10.3233/HSM-210005

Burns, R. A., Windsor, T., Butterworth, P., & Anstey, K. J. (2022). The protective effects of wellbeing and flourishing on long-term mental health risk. SSM - Mental Health, 2. doi:10.1016/j.ssmmh.2021.100052

Chen, D., Randhawa, G. S., Soltysiak, M. P. M., de Souza, C. P. E., Kari, L., Singh, S. M., & Hill, K. A. (2022). Mutational Patterns Observed in SARS-CoV-2 Genomes Sampled From Successive Epochs Delimited by Major Public Health Events in Ontario, Canada: Genomic Surveillance Study. JMIR Bioinformatics and Biotechnology, 3(1). doi:10.2196/42243

Comisión Económica para América Latina y el Caribe (CEPAL). (2022). Instituciones y políticas públicas para el desarrollo cooperativo en América Latina. https://www.cepal.org/es/publicaciones/47664-instituciones-politicas-publicas-desarrollo-cooperativo-america-latina​

Cordova-Pozo, K. L., Anishettar, S. S., Kumar, M., & Chokhandre, P. K. (2023). Trends in child marriage, sexual violence, early sexual intercourse and the challenges for policy interventions to meet the sustainable development goals. International Journal for Equity in Health, 22(1). doi:10.1186/s12939-023-02060-9

De Gouveia, R. H., Gulczynski, J., Canzonieri, V., & others. (2021). Rudolf Virchow: 200th birth anniversary. Virchows Archiv, 479, 1063–1065. https://doi.org/10.1007/s00428-021-03252-w

Díaz, L. A., Fuentes-López, E., Idalsoaga, F., Ayares, G., Corsi, O., Arnold, J., … Arab, J. P. (2024). Association between public health policies on alcohol and worldwide cancer, liver disease and cardiovascular disease outcomes. Journal of Hepatology, 80(3), 409–418. doi:10.1016/j.jhep.2023.11.006

Diaz, L. E., Yee, L. M., & Feinglass, J. (2023). Rates of breastfeeding initiation and duration in the United States: data insights from the 2016–2019 Pregnancy Risk Assessment Monitoring System. Frontiers in Public Health, 11. doi:10.3389/fpubh.2023.1256432

Dzantor, E. K., Kweku, M., Morhe, E. S. K., & Bugri, S. Z. (2023). Prioritizing Workplace Health Promotion Policy to Address High Blood Pressure and Obesity in a Public University in the Northern Region of Ghana. Inquiry (United States), 60. doi:10.1177/00469580231218627

Dzator, J., Acheampong, A. O., Dzator, M., Paolucci, F., Yawe, B. L., Asmah, E. E., … Gillespie, J. (2022). Policy Stringency, Handwashing and COVID-19 cases: Evidence from Global dataset. Health Policy and Technology, 11(2). doi:10.1016/j.hlpt.2021.100574

Ferruzzi, E. H., Ferruzzi, J. L. H., & Fernandes, R. M. F. (2022). Profiles of indigenous patients with epilepsy in a Brazilian village. Epilepsy and Behavior, 131. doi:10.1016/j.yebeh.2022.108703

Fuster-Casanovas, A., Fernandez-Luque, L., Nuñez-Benjumea, F. J., Conde, A. M., Luque-Romero, L. G., Bilionis, I., … Vidal-Alaball, J. (2022). An Artificial Intelligence-Driven Digital Health Solution to Support Clinical Management of Patients With Long COVID-19: Protocol for a Prospective Multicenter Observational Study. JMIR Research Protocols, 11(10). doi:10.2196/37704

Gao, C., Xu, J., Liu, Y. et al. Nutrition Policy and Healthy China 2030 Building. Eur J Clin Nutr 75, 238–246 (2021). https://doi.org/10.1038/s41430-020-00765-6

Guimarães, J. S. F., Mesquita, J. A., Kimura, T. Y., Oliveira, A. L. M., Leite, M. F., & Oliveira, A. G. (2024). Burden of liver disease in Brazil, 1996–2022: a retrospective descriptive study of the epidemiology and impact on public healthcare. The Lancet Regional Health - Americas, 33. doi:10.1016/j.lana.2024.100731

Gulis, G., Aringazina, A., Sangilbayeva, Z., Zhan, K., de Leeuw, E., & Allegrante, J. P. (2021). Population health status of the republic of kazakhstan: Trends and implications for public health policy. International Journal of Environmental Research and Public Health, 18(22). doi:10.3390/ijerph182212235

Haddad, S. M., Souza, R. T., Cecatti, J. G., Barreix, M., Tamrat, T., Footitt, C., … Tunçalp, Ö. (2020). Building a digital tool for the adoption of the world health organization’s antenatal care recommendations: Methodological intersection of evidence, clinical logic, and digital technology. Journal of Medical Internet Research, 22(10). doi:10.2196/16355

Hodder, R. K., O’Brien, K. M., Lorien, S., Wolfenden, L., Moore, T. H. M., Hall, A., … Summerbell, C. (2022). Interventions to prevent obesity in school-aged children 6-18 years: An update of a Cochrane systematic review and meta-analysis including studies from 2015–2021. eClinicalMedicine, 54. doi:10.1016/j.eclinm.2022.101635

Holt-Lunstad, J. (2022). Social connection as a public health issue: The evidence and a systemic framework for prioritizing the “social” in social determinants of health. Annual Review of Public Health, 43, 193–213. https://doi.org/10.1146/annurev-publhealth-052020-110732

Lezadi, S., Gholipour, K., Azami-Aghdash, S., Ghiasi, A., Rezapour, A., Pourasghari, H., & Pashazadeh, F. (2021). Effectiveness of non-pharmaceutical public health interventions against COVID-19: A systematic review and meta-analysis. PLOS ONE, 16(11), e0260371. https://doi.org/10.1371/journal.pone.0260371

Lqbal, M., & Zahidie, A. (2021). Diffusion of innovations: A guiding framework for public health. Scandinavian Journal of Public Health, 50(5), 581–584. https://doi.org/10.1177/14034948211014104

Irshad, C. V., & Dash, U. (2022). Healthy aging in India: evidence from a panel study. Journal of Health Research, 36(4), 714–724. doi:10.1108/JHR-09-2020-0395

Ji, X., Gao, L., Liu, H., He, S., Zhu, B., Chow, C., … Li, L. (2022). Does public health policy quality foster state innovation capacity? Evidence from a global panel data. Frontiers in Public Health, 10. doi:10.3389/fpubh.2022.952842

Kendall, S., Merritt, R., Eida, T., & Pérez-Escamilla, R. (2023). Becoming breastfeeding friendly in Great Britain—Does implementation science work? Maternal and Child Nutrition, 19(S1). doi:10.1111/mcn.13393

Lange, K. W. (2021). Rudolf Virchow and disease prevention and health promotion in the 21st century. Journal of Disease Prevention and Health Promotion, 5, 1–9. https://doi.org/10.5283/jdphp.34

Linquiti, P. Operationalizing Lasswell’s call for clarification of value goals: an equity-based approach to normative public policy analysis. Policy Sci 57, 193–219 (2024). https://doi.org/10.1007/s11077-024-09525-w

Ministerio de Salud del Perú. (2024). Informe de evaluación de la Política Nacional Multisectorial de Salud al 2030 “Perú País Saludable” correspondiente al año 2023. https://www.minsa.gob.pe/Recursos/OTRANS/09GestionIns/indicadores/2024/Informe%20de%20evaluacion%20de%20PNMS%202023.pdf​

Morishita, T., Takemura, M., Hayashi, M., Saito, K., Yamamoto, Y., Tsurumi, H., & Matsunami, H. (2024). Cohort profile: rationale and design of the Resource Center for Health Science (RECHS) project - a study of health hazards and medical cost burden among the Japanese population. BMJ Open, 14(2). doi:10.1136/bmjopen-2023-077720

Nutbeam, D., & Muscat, D. M. (2021). Health Promotion Glossary 2021. Health Promotion International, 36(6), 1578–1598. https://doi.org/10.1093/heapro/daaa157

Odediran, A., & Obeng-Gyasi, E. (2024). Association between Combined Metals and PFAS Exposure with Dietary Patterns: A Preliminary Study. Environments - MDPI, 11(6). doi:10.3390/environments11060127

Organización Mundial de la Salud. (2021). Paquete técnico SCORE para datos de salud. https://iris.who.int/bitstream/handle/10665/346557/9789240029026-spa.pdf​World Health Organization (WHO)

Organización Mundial de la Salud. (2022). Estrategia de la Organización Mundial de la Salud (2022-2026) para el Plan de Acción Nacional de Seguridad Sanitaria. https://www.who.int/es/publications/i/item/9789240061545​World Health Organization (WHO)+2repositum.tuwien.at+2scholarworks.waldenu.edu+2

Organización Panamericana de la Salud. (2020). Plan Estratégico de la Organización Panamericana de la Salud 2020-2025: La equidad, el corazón de la salud (Documento oficial: 359). Washington, D.C.: Organización Panamericana de la Salud.​ https://bvs.minsa.gob.pe/local/MINSA/5131.pdf?utm_source=chatgpt.com

Organización Panamericana de la Salud. (2022). Evaluación del desempeño de los sistemas de salud: un marco para el análisis de políticas. https://iris.paho.org/handle/10665.2/57392​

Padilla-Moseley, J., Blanco-Metzler, A., L’Abbé, M. R., & Arcand, J. (2022). A Program Evaluation of a Dietary Sodium Reduction Research Consortium of Five Low- and Middle-Income Countries in Latin America. Nutrients, 14(20). doi:10.3390/nu14204311

Peters, B. G., & Zittoun, P. (2024). Chapter 2: Teaching public policy through the history of the discipline, theories, and concepts. En E. St.Denny & P. Zittoun (Eds.), Handbook of Teaching Public Policy (pp. 17–34). Edward Elgar Publishing. https://doi.org/10.4337/9781800378117.00010

Pronk, N., Kleinman, D. V., Goekler, S. F., Ochiai, E., Blakey, C., & Brewer, K. H. (2021). Promoting health and well-being in Healthy People 2030. Journal of Public Health Management and Practice, 27(Suppl. 6), S242–S248. https://doi.org/10.1097/PHH.0000000000001254

Schnaufer, E. C. S., Barbosa, M. S., Marques, M. F. R., Brito, G. T., Ferreira, T. S., Ribeiro, A. D. C., … Simionatto, S. (2023). Prevalence of HIV-1 infection and associated characteristics in a Brazilian indigenous population: a cross-sectional study. The Lancet Regional Health - Americas, 25. doi:10.1016/j.lana.2023.100562

Shahim, B., Kapelios, C. J., Savarese, G., & Lund, L. H. (2023). Global public health burden of heart failure: An updated review. Cardiac Failure Review, 9, e11. https://doi.org/10.15420/cfr.2023.05

St.Denny, E., & Zittoun, P. (2024). Introduction to the Handbook of Teaching Public Policy. En E. St.Denny & P. Zittoun (Eds.), Handbook of Teaching Public Policy (pp. 1–15). https://doi.org/10.4337/9781800378117.00008

Staccini, P., & Lau, A. Y. S. (2022). Consuming Health Information and Vulnerable Populations: Factors of Engagement and Ongoing Usage. Yearbook of Medical Informatics, 31(1), 173–180. doi:10.1055/s-0042-1742549

Sullivan, M., & Green, D. (2020). Toward eliminating children’s lead exposure: A comparison of policies and their outcomes in three lead producing and using countries. Environmental Research Letters, 15(10). doi:10.1088/1748-9326/abb55e

Taira, K., Itaya, T., & Fujita, S. (2022). Predicting Smoking Prevalence in Japan Using Search Volumes in an Internet Search Engine: Infodemiology Study. Journal of Medical Internet Research, 24(12). doi:10.2196/42619

Tawde, P. P., Choudhari, S. G., Quazi Syed, Z., et al. (2024, August 29). Rudolf Virchow: Integrating medicine and social reform for public health. Cureus, 16(8), e68161. https://doi.org/10.7759/cureus.68161

Taylor, L. (2022). Monkeypox: WHO declares a public health emergency of international concern. BMJ, 378, o1874. https://doi.org/10.1136/bmj.o1874

Teeuwen, R., Psyllidis, A., & Bozzon, A. (2023). Measuring children’s and adolescents’ accessibility to greenspaces from different locations and commuting settings. Computers, Environment and Urban Systems, 100. doi:10.1016/j.compenvurbsys.2022.101912

Túri, G., & Virág, A. (2021). Experiences and lessons learned from covid-19 pandemic management in south korea and the v4 countries. Tropical Medicine and Infectious Disease, 6(4). doi:10.3390/tropicalmed6040201

Umair, A., Masciari, E., & Ullah, M. H. (2023). Vaccine sentiment analysis using BERT + NBSVM and geo-spatial approaches. Journal of Supercomputing, 79(15), 17355–17385. doi:10.1007/s11227-023-05319-8

Webb, K. A., Mavhu, W., Langhaug, L., Chitiyo, V., Matyanga, P., Charashika, P., … Neuman, M. (2021). ‘I was trying to get there, but i couldn’t’: Social norms, vulnerability and lived experiences of home delivery in Mashonaland Central Province, Zimbabwe. Health Policy and Planning, 36(9), 1441–1450. doi:10.1093/heapol/czab058

Whitty, M., Breen, H., Paterson, M., & Sollis, K. (2021). Health Promotion Strategies to Address Gambling-Related Harm in Indigenous Communities: A Review of Reviews. Critical Gambling Studies, 2(1), 39–54. doi:10.29173/cgs29

Woolhandler, S., Himmelstein, D. U., Ahmed, S., Bailey, Z., Bassett, M. T., Bird, M., et al. (2021). Public policy and health in the Trump era. The Lancet, 397(10275), 705–753. https://doi.org/10.1016/S0140-6736(20)32545-9

Zare, M., Galea, K. S., Viegas, S., Fantke, P., Louro, H., Theunis, J., … Hopf, N. B. (2023). FAIR environmental and health registry (FAIREHR)- supporting the science to policy interface and life science research, development and innovation. Frontiers in Toxicology, 5. doi:10.3389/ftox.2023.1116707

Zavaleta, E. M. (2023). La corrupción en la administración pública y su impacto en el desarrollo político, económico y social, en el contexto peruano. Comuni@cción, 14(1), 72–85. https://doi.org/10.33595/2226-1478.14.1.786

Zavaleta, E. M. (2025). Importancia de la meritocracia en el desarrollo de las políticas públicas: una revisión sistemática. Comuni@cción, 16(1), Artículo e1279. https://doi.org/10.33595/2226-1478.16.1.1279

1. Médico Cirujano. Maestría en servicios de la salud. Universidad Cesar Vallejo. Perú. E-mail: gsamame@ucvvirtual.edu.pe