Urban health

Cross-sector partnerships in São Paulo, Brazil

21 April 2021
3 min read

In São Paulo, we researched how cross-sector partnerships and collaboration are at the heart of successful initiatives to address global health concerns.

This city profile is part of a series of ten, exploring how cities around the world are addressing health inequalities. Read the full report and sign up to receive more insights from us.

About São Paulo

Home to 12 million residents, São Paulo is the most populous city in Brazil. Larger than London in both size and population, São Paulo has the highest GDP in Latin America and is Brazil’s most multicultural city, with a history of immigration.

One survey estimates that São Paulo is a majority white city (60%), but still quite diverse with 30% of residents identifying as multiracial and 6.5% as Black. Brazil’s system of racial classification is controversial: many Brazilians do not identify with any of the categories, resulting in a variety of sometimes contradictory measures to identify and understand differences between racial and ethnic groups.

São Paulo is characterised by the extreme polarisation between its ultra-low and ultra-high-income populations. While rates of poverty are actually lower in relative terms compared to London, what poverty looks like in São Paulo is very different. Nearly a third of São Paulo’s population, around 3 million people, live in slum-like conditions or favelas.

Nearly half of residents access healthcare primarily through universal government coverage. Between 2001 and 2012, the city saw a significant level of expansion of public health services specifically in marginalised areas, although concerns remain regarding the quality of service received compared to private health providers.

In numbers


inhabitants in São Paulo


of residents identify as multiracial


people live in slum-like conditions

Collaborating with others for Better Hearts Better Cities

Working with local authorities and partners from different sectors, the Novartis Foundation’s Better Hearts Better Cities initiative addressed hypertension – the leading risk factor for cardiovascular diseases – by testing pioneering models and initiatives that achieved impact at scale.

In each participating city, it built networks of partners that reached beyond the health sector and focused on prevention, engaging the community through co-creation and improving quality of care delivery in the healthcare system, summarized in the Foundation’s CARDIO-approach.

Solutions are designed based on insight gathered from users and public employees at workshops, unlocking local intelligence, before expanding on a larger scale. Partners included city governments, healthcare providers, but also digital and telecommunication organisations, food suppliers, employers, insurance funds, social enterprises and civil societies.

The Novartis Foundation selected the São Paulo-based Tellus Group as their implementation partner on the ground. Grupo Tellus aims to generate social impact through innovation and design of public services. They work directly with different stakeholders from street level to government.


How has this approach supported improvements in health?

Better Hearts Better Cities worked. In São Paulo, preliminary data showed that blood pressure control nearly tripled after just 18 months of implementation. This is important given that uncontrolled high blood pressure is a leading risk factor for stroke, heart attacks and heart failure and directly impacts mortality and morbidity.

Led by the Municipal Health Secretariat of São Paulo, the initiative has achieved this by engaging and building a common focus of multi-sector partners towards health, impacting primary health delivery and management and engaging communities in the care process, prevention, healthy living and well-being.

This cross-sector approach has brought more and different people into primary care to monitor their blood pressure through engaging activities which appeal to wider groups. Overall, the improvements in management of NCDs at primary care level, guided by the newly developed, official treatment protocol “Caring For All”, have led to better prevention, monitoring of patients and disease as well as data-based measuring of progress.

Belonging is a key condition – health service teams users need to buy into the project and see it as an advantage for the citizens. If managers or decision makers are not convinced they could hinder or block the project. It is important to keep re-engaging and designing with them, and practice active listening to understand political priorities.

Germano Guimarães Co-Founder and CEO of Tellus Group
Mother and child at a street market

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