São Paulo, Brazil: Green and Healthy Environments Programme

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City: São Paulo
Country: Brazil
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Initiative: Green and Healthy Environments Programme

São Paulo is the largest city in Brazil with approximately 12 million inhabitants. There is constant concern about socio-environmental issues. In 2005, the Municipal Green and Environment Secretariat (SVMA), the Municipal Health Secretariat (SMS) and the Municipal Social Development Secretariat (SMADS) developed the Green and Healthy Environments Programme (PAVS) with the purpose of strengthening public policies and building environmental health management, with the active participation of the community. 

In 2008, the SMS incorporated PAVS as a programme in the Family Health Strategy, within the scope of Primary Care, with the aim of including environmental issues in Health Promotion actions. consolidating a more comprehensive conception of health and the environment with an emphasis on the social determinants of the health-disease process. PAVS also seeks to foster new health practices that translate into values of citizen responsibility in defence of life and the environment. To strengthen intersectorality, fostering empowerment and effective community participation. And, to contribute to integrated public policies in the Municipality of São Paulo with an emphasis on environmental issues surrounding the health of the population.

The programme develops its actions and projects with a focus on six guiding axes that interrelate Solid Waste Management; Biodiversity and Afforestation; Vegetable Gardens and Healthy Eating; Revitalisation of Public Spaces; Water, Air and Soil; and the Environmental Agenda in Public Administration. In 2020, there was a need for a diagnosis that pointed out the real needs of the territory based on environmental risks and their relationship with the epidemiological profile of the areas covered by the Basic Health Units.

For this, the Manual to Elaborate the Socio-Environmental Diagnosis was developed, which consists of a local management tool with an emphasis on recognising the territory. This document enables participatory planning of local and intersectoral actions, and directs health practices towards interventions focused on the population’s health needs and problems. It also identifies, classifies and georeferences the socio-environmental risks and potentialities of the territory on digital maps and systematises the presentation of the data collected using specific graphics. This advances the identification of priority problems with possibilities for interventions by the Basic Health Unit teams.

In 2023, there was evidence of the expanded use of the diagnosis as a planning tool for the Surveillance Centres of the Basic Health Units, as well as the partnership established with the Municipal Department of Urban Planning and Licensing (SMUL) to make data available on a digital public platform for the city of São Paulo.

The team currently has 330 Environmental Promotion Agents who work together with more than 9,000 community health agents and various sectors and actors in the area, such as the sub-city councils, the community, local businesses, churches and schools, to develop their actions with a focus on environmental health. As of 2023, all projects and actions are related to the Sustainable Development Goals (SDGs), incorporating the concept of One Health in its interdependence and interconnection, in line with the 2030 Agenda.

Benefits of Urban Greening

Harnessing the Power of Plants

The 2021 IPCC Report cites the serious impacts of increased greenhouse gas emissions on all regions of the planet. Besides that, according to the World Health Organization, more than 24% of diseases have environmental causes and 28% of deaths among children under five are due to modifiable environmental factors.

The Programme aims to promote better life quality with the ecosystem capacity to improve the environment. The general vision of the initiative is the prevention of diseases through healthy environments and environmental education, integrating the various actors in the territory, community, institutions and health professionals. The programme is also supported by the National Health Promotion Policy, one of whose objectives is to favour the preservation of the environment and the promotion of safer and healthier environments.

All PAVS actions are directly related to climate change, considering that these impacts affect the health of the population. The programme’s projects and actions focus on anthropogenic actions that interfere with health and work not only on environmental education but also on local intervention practices and the prevention of diseases related to socio-environmental factors.

Delivering Multiple Benefits

The programme began as a project conceived by the Municipal Department of Greenery and the Environment with the participation of three other departments, Health, Social Assistance and Education. It also involved multilateral international technical cooperation and academic institutions.

Over the course of the project, the Municipal Health Department incorporated the proposal as the Green and Healthy Environments Programme, drawing up the entire structure. In 2011, the Green and Healthy Environments Programme (PAVS) was incorporated into the Family Health Strategy (ESF) in the Primary Care Coordination of the Municipal Health Secretariat (SMS) of the Municipality of São Paulo. The team is composed of two municipal coordinators, six regional managers, 36 local managers and 330 Environmental Promotion Agents who talk to more than 9,000 Community Health Agents.

PAVS supports Decree No. 51.435 of April 26, 2010, which regulates LAW No. 14903. of February 6, 2009, which institutes the Programme for the Production of Herbal Medicines and Medicinal Plants in the municipality of São Paulo.

PAVS has a Technical Cooperation Agreement with the Department of Greenery and the Environment for the development of actions in environmental education and health including awareness-raising activities, guidance, information to the community and environmental and health education, with an emphasis on municipal parks and territories covered by the Family Health Strategy.

The City’s Bold and Innovative Vision

The programme aims to strengthen intersectoral management of environmental issues that impact the population’s health. This involves the promotion of attitudes towards environmental preservation, conservation and recovery, and the promotion and protection of the population’s health.

The PAVS works with an integrated agenda, seeking to highlight the determinants of the health-disease process. It focuses on the development of health and environment policies, the strengthening of intersectorality at local level, the sustainability of interventions in the territory and the empowerment and effective participation of the community. This approach has been strategic in strengthening Primary Care in the city of São Paulo.

The involvement is of great importance in the implementation of this Programme of Community Health Agents (ACS), who are seen as multipliers of Health Promotion and environmental sustainability. They have been trained to identify and prioritise environmental problems with an impact on health, in areas of greater vulnerability, as a result of their work with the population and because they work and live in the territories, thus favouring intervention processes at the local level.

PAVS is the only programme in the country with this methodology for working and developing projects and actions, and can serve as a reference for other municipalities.

Partnerships and Collaboration

The PAVS has been working with a wide range of stakeholders since its conception to make it possible to carry out a programme that is essentially intersectoral.

An example of this is the partnership that has existed with the Department of Greenery and the Environment since the start of the programme. In addition, the following are examples of collaborative work:

  • Human Rights Secretariat (training cycles on topics related to racial discrimination, environmental racism, violence, gender, etc.).
  • Supply of data to the Urban Planning and Licensing Department, which will be made available through the data platform.
  • There were also activities with students from the public school system, through the PSE – Health at School Programme, bringing up health and environmental issues.
  • The partnership with the Zoonosis Surveillance Division involves educational activities, home visits and the collection of synanthropic animals for investigation.
  • In 2022, there were 2,866 intersectoral links for PAVS actions and projects.

Addressing Urban Challenges

The Issue

The city of São Paulo has a territory of around 914,5644 km² with housing needs and a large fleet of vehicles that contribute to air pollution. In the metropolitan region, more than two million people live in areas of socio-environmental vulnerability. In these areas, there are many points that can pose environmental health risks, such as streams and waste sites that can attract rodents and other disease-transmitting animals, as well as environmental risks such as possible flooding and landslides.

The Impact of the Issue

The programme was conceived because many health problems could be reduced by changing habits and effective health promotion practices. The PAVS emerged to strengthen integrated management in the territory for the development of an agenda for the protection and ‘promotion of green and healthy environments.

Based on this integrated strategy of actions in the territory and with a holistic approach, the aim is to resolve these problems. Without this approach and the PAVS, these problems could persist with isolated actions to solve complex and highly interdependent problems.

Environmental home visits were carried out in 170,487 households, observing environmental aspects that pose a risk to health, such as the presence of larvae of the Aedes aegypti mosquito, which causes dengue fever.

A Nature Orientated Future

Using data from the Socio-Environmental Diagnosis collected in the area, the PAVS informs the management of the Basic Health Unit, in the form of a report, of the main problems that will be prioritised in local projects and actions. In 2022, the programme planted 7,408 trees and distributed 3,725 seedlings to local residents. There were also 277 revitalisations of public spaces at points of irregular waste disposal and 18,625 collective environmental activities impacting 759,965 people.

Nature Positive Solutions


PAVS began as a project developed between 2005 and 2008 in conjunction with the United Nations Environment Programme (UNEP). It was funded by the São Paulo City Council, the Inter-American Development Bank (IDB), the Ministry of Health and UNEP. (Phase 1)

In September 2008, with the completion of the training process for Community Health Agents and Social Protection Agents, the Municipal Health Department (SMS) incorporated the Green and Healthy Environments Programme (PAVS) into the Family Health Strategy (ESF), under the Coordination of Primary Care. The aim was to stimulate new practices in the field of Health Promotion at local level and strengthen the capillarity of the actions of Community Health Agents (ACS) in their territories. During this phase, Environmental Promotion Agents were hired to work on incorporating environmental issues into health promotion actions through projects and actions within the community and in conjunction with various local players, such as subprefectures, businesses and schools.

The programme was implemented with the aim of reducing health problems through preventive actions and new effective health promotion practices in areas with significant social inequalities, environmental problems and health risks.


The Programme has 15 years of implantation, demonstrating the continuity of the project. Many administrations have passed by the city and PAVS including legal biding instruments, such as the Municipal Health Plan, which approaches health in the City as a whole and has added PAVS as a permanent instrument of governance in the City.

Besides that, PlanClima, a multisector municipal plan to address climate change in the City, cites PAVS as an instrument to implement many of the strategies regarding climate change.

Multi-Stakeholder Support

A target in the Municipal Climate Change Plan proposes expanding the programme to all Basic Health Units, which currently total 470 in the municipality.

In 2022, a Technical Cooperation Agreement was made with the Municipal Department of Greenery and the Environment, for the development of environmental education and health actions to be materialised in awareness-raising, guidance and information activities for the community, with an emphasis on municipal parks and territories.

The health teams carry out collective environmental actions in the territories covered by the Basic Health Units, where they work in places such as municipal schools, parks and other collective spaces, and also provide guidance on these issues during environmental home visits.

Over the last five years, 2,776,237 people have taken part in PAVS projects and actions, with 126,907 collective environmental actions and 536,367 environmental home visits to raise awareness of environmental health issues.

Management and Maintenance

The programme has targets in its annual health planning, holds technical meetings throughout the year and promotes training for Environmental Promotion Agents.

Measuring and Reporting Impact

Monitoring Results

For monitoring purposes, the programme has quantitative indicators that make it possible to evaluate the development of actions in the territory. This data used to be entered manually into an Excel spreadsheet. Now, with the support of the Information and Communication Technology Department of the Municipal Health Department, a system has been developed that allows data to be collected in real time, with the acquisition of tablets.

Demonstrating Progress

In addition to the quantitative indicators published annually on the programme’s website, the data from the Socio-Environmental Diagnosis available on the public georeferencing platform of the Urban Planning and Licensing Department, the links with other departments and NGOs, allows the programme to strengthen and contribute to the city of São Paulo.

Measuring Impact

Every year, we hold an event called the PAVS Balance Sheet to disseminate data on the quantitative indicators collected throughout the year. This data is published on the programme’s website: https://www.prefeitura.sp.gov.br/cidade/secretarias/saude/atencao_basica/pavs/index.php?p=215718

Learning and Transferability

Adaption and Enhancement

The programme has targets in its annual health planning, holds technical meetings throughout the year and promotes training for Environmental Promotion Agents. For monitoring purposes, the programme has quantitative indicators that make it possible to evaluate the development of actions in the territory. This data used to be entered manually into an excel spreadsheet and now, with the support of the Information and Communication Technology Department of the Municipal Health Department, a system has been developed which allows data to be collected in real time.

Potential for Replication

The initiative is easily replicable because it is a simple and inexpensive solution, which only requires coordination and strategic direction for environmental goals and capillarity in the territory. The great advantage is precisely the ease with which the solution can be replicated and the potential for scale and impact.

The Socio-Environmental Diagnosis, which is a tool for prioritising PAVS projects, was recognised by the Health Surveillance Units. The data from this diagnosis is gradually being made available on a public georeferencing platform, GEOSAMPA.

Inspiring Other Cities

The Green and Healthy Environments Programme is a programme run by the São Paulo Municipal Health Department and is developed by social health organisations, some of which provide services in other municipalities across the country. In this sense, other municipalities have the opportunity to learn about the programme’s development methodology and implement it in their territory. The municipality of Fortaleza in the state of Ceará hired environmental promotion agents to include environmental issues in health promotion actions. Another organisation has also taken the proposal to the municipality of Mogi and is waiting for feedback.


Reducing Negative Impacts and Ensuring Sustainability

All the programme’s actions contribute directly and indirectly to reduce the carbon footprint, but this indicator is not quantified.

Environmental Considerations

In the last five years, 5,489 tree seedlings have been planted by the programme with the involvement of the community for caretaking, and 5,375 seedlings were distributed in 2021 and 2022. PAVS, as a form of teaching and a tool for health promotion, such as encouraging fresh food and good mental health, has 130 gardens and has supported more than 3,600 people. In addition, the implementation and construction of cisterns to capture rainwater in some units through workshops with the residents who attend the health unit serves as an example, as does the implementation of voluntary waste drop-off points in more than 250 Basic Health Units.

Use of Natural Resources

From 2018 to 2022, PAVS supported the São Paulo State Basic Sanitation Company in the New Pinheiros River Project through environmental education in the communities. In addition, PAVS is constantly working on actions to raise awareness of the rational use of water and guidance on water-borne diseases. Last year it implemented the More Health, Less Plastic project, which guides employees and the community in reducing their consumption of plastic packaging and disposing of it correctly in recycling garbage cans.