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Bogotá crea Comisión Intersectorial para reducir desigualdades en salud y bienestar – Decreto 397 de 2025
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El Distrito Capital expidió el Decreto 397 de 2025, con el cual se crea la Comisión Intersectorial Distrital de Determinantes Sociales de la Salud y el Bienestar (CIDDSSB). Esta instancia, liderada por el Alcalde Mayor de Bogotá, busca consolidarse como el espacio de gobernanza en salud pública y Atención Primaria Social (APS Social), con el mandato de coordinar políticas y acciones intersectoriales que impacten de manera directa en los determinantes sociales de la salud y el bienestar de la población.
El decreto establece que la CIDDSSB será responsable de “coordinar, orientar y articular la acción intersectorial de políticas, planes, programas, proyectos o estrategias relacionadas con los determinantes sociales que afectan la salud y el bienestar”.
Su alcance principal será promover la co-gestión de temas estratégicos y priorizados en el Plan Distrital de Desarrollo vigente, con un énfasis en la reducción de desigualdades sociales y territoriales. La estrategia contempla mecanismos de integración, interoperabilidad de información y análisis de inequidades para respaldar la toma de decisiones basadas en evidencia.
Fundamentos normativos y vacíos que motivaron su creación
El nuevo decreto responde tanto a un marco normativo nacional como a necesidades específicas del Distrito:
- Constitución Política de Colombia (1991): fundamenta la acción en los principios de igualdad, eficacia, coordinación administrativa y derecho a la salud.
- Ley 1438 de 2011: define la intersectorialidad como acción clave para abordar determinantes sociales de la salud.
- Ley 1751 de 2015: ordena al Estado reducir desigualdades en determinantes sociales para garantizar el derecho fundamental a la salud.
- Decreto Nacional 1005 de 2022 y Plan Decenal de Salud Pública 2022-2031: establecen la necesidad de fortalecer instancias de articulación intersectorial en todos los territorios.
En la capital, la derogatoria del artículo que sustentaba el Comité Intersectorial Distrital de Salud (Acuerdo Distrital 761 de 2020) dejó un vacío institucional. Aunque dicho Comité continuó funcionando de hecho, carecía de soporte normativo. El Plan Distrital de Desarrollo 2024-2027, Bogotá Camina Segura, fijó como meta crear un espacio formal de gobernanza intersectorial en salud pública, compromiso que se concreta con la expedición del Decreto 397 de 2025.
Es clave mencionar que el documento incluye definiciones estratégicas que orientan la gestión:
- Determinantes Sociales de la Salud (DSS): condiciones en que las personas nacen, crecen, trabajan y envejecen, influenciadas por políticas y sistemas sociales.
- Atención Primaria Social (APS Social): estrategia que trasciende el sector salud, promueve interoperabilidad de información, gestión del riesgo y articulación de servicios sociales y sanitarios.
- Intersectorialidad: colaboración horizontal entre sectores, con impacto vinculante de las políticas de un sector sobre los demás.
- Gobernanza y gobernabilidad: capacidades institucionales para ejecutar políticas públicas efectivas, garantizar derechos y asegurar participación ciudadana.
- Interoperabilidad de la información: integración de datos sectoriales e intersectoriales para monitoreo y decisiones en salud y bienestar.
¿Cómo estará integrada la Comisión?
La Comisión estará integrada por:
- El Alcalde Mayor de Bogotá o su delegado (Secretario General).
- Secretarios de Salud, Integración Social, Educación, Cultura, Mujer, Desarrollo Económico, Ambiente y Gobierno.
Adicionalmente, podrá convocar a entidades distritales no permanentes y a actores sociales, privados, ONG o cooperación internacional, quienes tendrán derecho a voz en discusiones priorizadas.
El decreto exige que los delegados designados pertenezcan al nivel directivo de cada entidad, garantizando capacidad decisoria y responsabilidad institucional.
Estas son las funciones estratégicas del CIDDSSB
El decreto también detalla funciones concretas a la CIDDSSB, entre ellas:
- Articular políticas y programas intersectoriales para reducir inequidades en salud y bienestar.
- Diseñar y aprobar planes de trabajo anuales con enfoque territorial.
- Orientar instancias locales de gobierno y participación, promoviendo estrategias de gestión integral de riesgos.
- Impulsar mecanismos de interoperabilidad de información, asegurando integración de bases de datos sectoriales.
- Promover la creación de Unidades Técnicas de Apoyo que respalden la implementación de decisiones.
- Elaborar su propio reglamento interno en un plazo máximo de cuatro meses.
Las sesiones ordinarias se realizarán cada cuatro meses, con posibilidad de reuniones extraordinarias. Por otra parte, la Presidencia de la Comisión será ejercida por el Alcalde Mayor o el Secretario General. Entre sus responsabilidades se incluyen suscribir actos, aprobar el plan de trabajo anual y garantizar la articulación interinstitucional.
La Secretaría Técnica recaerá en la Secretaría Distrital de Salud, encargada de elaborar documentos técnicos, convocar sesiones, consolidar informes y coordinar con otras instancias como el Consejo Distrital de Seguridad Social en Salud.
Interoperabilidad y articulación institucional
Uno de los pilares del decreto es la integración de información sectorial e intersectorial. La Comisión deberá establecer mecanismos de interoperabilidad que permitan la gestión compartida de datos, respetando las normativas distritales y nacionales, y garantizando transparencia en la divulgación de resultados.
Además, se prevé la articulación con instancias del Sistema de Coordinación del Distrito Capital, asegurando coherencia entre los diferentes niveles de gobierno y evitando la duplicidad de esfuerzos.
Vigencia y modificaciones normativas
El Decreto 397 de 2025 adiciona el artículo 8° del Decreto Distrital 546 de 2007, incorporando a la CIDDSSB dentro de las comisiones intersectoriales de la Administración Distrital. De igual forma, deroga artículos del Decreto 812 de 2017 relacionados con instancias de articulación previas, y entra en vigencia al día siguiente de su publicación en el Registro Distrital.
Entre tanto, la normativa representa un avance estratégico en la gestión de salud pública en Bogotá, al consolidar una instancia formal de gobernanza intersectorial que reconoce que el bienestar no depende solo del sector salud, sino de factores sociales, económicos, educativos, ambientales y culturales.
Con la CIDDSSB, el Distrito busca reducir inequidades históricas, fortalecer la Atención Primaria Social como eje de acción y generar un modelo articulado que permita decisiones basadas en evidencia, participación ciudadana y uso compartido de la información.
En términos prácticos, este paso normativo coloca a Bogotá en una posición de liderazgo nacional en la integración de políticas de salud y bienestar, con el desafío de traducir la coordinación intersectorial en resultados tangibles que mejoren la calidad de vida de la población.
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