MY 2003 DISCOVERY: A LEADER, A TEAM AND AN EFFECTIVE MULTIPLE INTERVENTIONS PROGRAM IN BOGOTA, COLOMBIA

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My resource in the year 2003 is the Bogotá City Mayor and his team. I found their health promotion intervention program as a very valuable resource. It was a very effective and original approach with several innovative strategies that might be widely applicable. It illustrated how important it is to implement a multi disciplinary and multi sectoral program in health promotion. They created innovate methods in health education and behavior change through humorous and symbolic communication that appears to be very effective in our cultural and social environment. Those experiences give us new tools and ideas for future interventions.

In 1994 Mr. Antanas Mockus was elected as the City Mayor of Bogotá, the 6.5 million inhabitant’s capital of Colombia. He is a mathematician, philosopher and a university teacher who uses symbolic humorous communication. Given his style and background, many politicians and even academics doubted of his ability to deal with the serious problems of the capital city. Mr Mockus started in the mayor’s office early in 1995 for a period of 3 years; he was replaced in that position by Mr. Enrique Peñalosa in the period of 1998 - 2000 and was reelected for the period of 2001 - 2003.

According to the medical examiner institute, both the homicide rate and the rate of deaths in traffic accidents in the city, dropped to less than half from the year 1993 to the year 2003.

To reduce the high mortality and morbidity due to homicides and traffic accidents, the city administration used a variety of health promotion approaches and strategies continuously from 1995 to the year 2003 when Mr. Mockus finished his second mandate. The foundation of his program was the conceptual framework of the high value of human life, the importance of “congruous living” among citizens and the safety of the citizens, not just the security of the institutions. The former concept to confront insecurity based on the trilogy Police-Justice-Prison evolved to an integral security and congruous living policy that contemplated preventive actions. The social and cultural barriers were strengthened against the transgression of rules, aggression against life and integrity of persons, and to support pacific congruous living and concerted resolution of conflicts. These actions were directed primarily to the most vulnerable groups and were complemented with programs of prevention of factors associated with violence, recuperation of public space and urban environments, improvement of the justice and reclusion infrastructures and, finally, of police training in the rational use of law enforcement. There were several innovative strategies used to deliver the messages and to educate and motivate people to change behavior.  Here are some examples.

To reduce the high mortality of pedestrians, the city administration contracted several groups of buffoons, mimics and clowns to surprise and mock the car drivers standing over the “zebras” (demarcated space for pedestrians to cross at the intersections) and to the pedestrians not paying attention to the traffic lights. In several interviews, drivers and pedestrians were more afraid of being mocked than being punished by the police. The implementation of a massive public transportation system by buses and its infrastructure development (Transmilenio) contributed also to an important reduction of fatal injuries on the roads. 

To reduce homicide and change the violent culture, the city authorities combined law enforcement and people behavior change. They made a resolution that restricted the carriage of guns and promoted a voluntary exchange of guns for a bonus of about 100.000 pesos. At the city schools, all children had the chance to exchange weapon toys for books or videos.

To reduce homicide and motor vehicle accidents, the mayor decided to prohibit the selling of alcohol in public places and stores from 1:00 a.m. to 6:00 a.m. These regulations were combined with compulsory educational programs, community work and other innovative and sometimes surprising educational methods.

The Mockus-Peñaloza-Mockus administrations have thus developed a highly successful intervention program that used several strategies and tools in health promotion. They created a conceptual framework, developed and implemented policy, fostered public education and motivation, and built infrastructure that all together contributed to reduce the high mortality and morbidity in the city. Their intervention generated a different new life style among the citizens, with raised consciousness about rights and obligations, a life style more tolerant, more respectful, more harmonious and less indulgent to crime and abuses.

Unfortunately most of the interventions were not evaluated individually; some qualitative research is being done but a more structured evaluation program is needed to better understand how the interventions produced the impact.

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