Issues of high relevance for sustainable health: a validation study in Portugal, 2021

Background and Objective: The 2030 Agenda for Sustainable Development represented a decisive advance for the planning and implementation of sustainable health strategies. Instruments such as the GAPFRAME framework are available to support its complex operationalization. The need to identify sustainability issues of high relevance to health was felt within the scope of the National Health Plan 2021-2030 of Portugal (NHP 2021-2030), not being known a validated reference for Portugal. The objective of this study is to assess the internal consistency of a framework for translating the Sustainable Development Goals (SDGs) into relevant issues for achieving high levels of sustainable health and well-being in Portugal, adapted from the GAPFRAME. Methods: A descriptive study was conducted with data collection through a selfcompletion questionnaire, applied to 127 stakeholders of the NHS 2021-2030. Data were collected related to the perceptions about thirty-two sustainability issues as determinants or facilitators of achieving high levels of health and wellbeing. Issues were organized according to four sustainability dimensions (planet, society, economy and governance) in a frame adapted from GAPFRAME. Internal consistency was assessed using Cronbachs alpha coefficient. Results: Seventy-five stakeholders participated (59.1%); 55 (75.3% of valid responses) reported working in the health area and 64 (85.3%) in the public sector. Fifty-five (in 61 valid responses) were from the social sector and 13 from the environmental and, or economic sectors. Cronbachs alpha coefficient of the framework as a whole was 0.93, varying between 0.76 (dimension: society) and 0.97 (dimension: planet), compatible with moderate to excellent internal consistency (0.84 for dimension: economy; 0.91 for dimension: governance). Conclusions: The framework adapted from the GAPFRAME model seems to have adequate precision for its use in Portugal as a tool for translating the SDGs into relevant issues to include in the planning for sustainable health and well-being.