Health in All Policies: a majortool to address health inequity

Abdi Momin AHMED, Regional Advisor Health Policy & Planning

Health Systems capacityDevelopment Workshop

Tehran, Islamic Republic of Iran, 11-15 July, 2010

Objectives of the session• Elucidate the history, concept and the use

of HiAP initiative

• Illuminate its scope and why it is vital indd i h lth i itaddressing health inequity

• Define HiAP approach & strategy toadvance it

• Share the recent Adelaide statement onHiAP declaration

What is Health in All policiesWhat is Health in All policies(HiAP) initiative?(HiAP) initiative?

•Is an innovative policystrategy that responds to thecritical role that health playsin economies & social life ofthe 21st century societies

European Observatory on health systems, 2006

History ofHistory of HiAPHiAP initiativeinitiative• HiAP can be traced all the way back to & beyond

the Alma Ata Declaration, 1978• Ottawa charter for health promotion in 1986

defined health promotion as a process of enablingpeople to increase control and to improve theirhealthhealth

• Ottawa charter sets out five strategies for healthpropmotion:- Build a healthy public policy- Creating supportive environments- Strengthen community actions- Develop personal skills- Reorient health services

HiAP ConceptHiAP Concept

• Is a horizontal complimentary policyrelated strategy contributing to improvepopulation health. The core of HiAP is top pexamine determinants of health that canbe altered to improve health but aremainly controlled by policies of sectorsother than health.

European observatory, 2006

What HiAP introduces?What HiAP introduces?

• Improved population healthoutcomes & closing the health gap asa shared goal across all parts ofa shared goal across all parts ofgovernment and addresses complexhealth challenges through anintegrated policy response acrossportfolio boundaries

• HiAP allows government to addressthe key health determinants ofhealth in a more systematic manner

• HiAP is committed to theachievement of sustainability & thehealth & wellbeing of both presentand future generations

What is the scope of HiAP?What is the scope of HiAP?

• HiAP address the effects on healthacross all policies such asagriculture education environmentagriculture, education, environment,fiscal policies, Labour, workplace,housing and transport

Health & Economy: evidencesHealth & Economy: evidences• The work on macroeconomics & health based on empirical

evidence from low & middle income countries made astrong case for investing in health

• There is a sound & empirical basis that human capitalcontributes to economic growth since human capitalcontributes to economic growth since human capitalmatters for economic outcomes & since health is animportant component of human capital, health matters foreconomic outcomes.

• At the same time economic outcomes also matters forhealth

Why health in all policies?Why health in all policies?• Policies shape the conditions in which we live,

grow and work

• factors that found to have the most significantinfluence on health are called determinants ofinfluence on health are called determinants ofhealth

• Health in all policies is based on values &principles similar to those in WHO’s call formultisectoral action for health & the concept ofbuilding healthy public policies

• A Policy with negative consequences for health ofthe populations will put extra burden on theeconomy and health care systems

• Compensating the negative health effects of apolicy by health care interventions may turn tobe difficult and costly

• HiAP is a strategy with a solid background inscience which aims at influencing healthdeterminants so as to improve, maintain andprotect health

• The ultimate aim of HiAP is to improve evidencebased policy-making

What is a HiAP Approach?What is a HiAP Approach?• Is based on the recognition that the population

health is not merely a product of health sectoractivities

• It is about the recognition of population healthand health determinants it also concernsand health determinants, it also concernsaddressing policies in the context of policymaking at all levels of governance

• Is to set up a strong legal basis that providesstrong mandate for government institutions. Forexample European community treaty providesstrong mandate for European institutions tosupport HiAP

Required strategy toRequired strategy toadvance HiAPadvance HiAP

• Prevailing conditions:- A major share of policy work needs to be performedoutside the health sector- convincing the health sector of the importance of HiAPapproach because of the following:i) existing tendency within the health sector to medicalizei) existing tendency within the health sector to medicalizeor neglect the many external causes of poor health and therole of other sectorsii) the effects of environmental, social, agricultural andeconomic policies and programmes are still neglected byprofessional groupsiii) the urgent need to strengthen & coordinate healthdevelopment at international and local levels

Strategy cont’dStrategy cont’d

• Joined-policy making initiative- health is notthe only sector that needs cooperation

- Cross-cutting objectives shout be clearly defined- Joint working arrangements with other sector are defined- barriers to effective joined-up policy-making are clearlyidentified with a strategy to overcome them- Enhance the feasibility of placing health criteria on the agendaof policy-making- Mutual gains strategy ( win-win situation) for examplesmoking- synergy model strategy (achieving more together thanworking alone)

Strategy cont’dStrategy cont’d• Crisis situation opens a window of

opportunity:- policies are advanced in times of crisis- health objectives are taken higher on the

liti l dpolitical agenda

- good policies can be devised only if therequired expertise exist that can producesolutions and alternatives for the emergingsituation......look at the BSC, SARS, AI, Swineflu, Ebola, cholera, Chernobyl etc

Enhancing capacities for HiAP: EUEnhancing capacities for HiAP: EUexperienceexperience

• HiAP calls for conceptual, analytical, managerial& political skills

- New partnership calls for flexibility, negotiatingskills and ability to work with differentskills, and ability to work with differentdisciplines and interest groups

- Intersectoral actioni) Horizontal public health committeeii) Formal consultations on for eg. Legislationiii) Ad hoc committees on specific initiativesiv) Intersectoral policies & programsv) Public health reportingvi) Health impact assessemnt

Health in other sectoralHealth in other sectoralpolicespolices

• Transport: health component to reducedeaths

For example:- Smoke free public transport- improved access for disabled- environmentally friend schemes as “metro services”- improved access to all communities- improved safety & security- improved pedestrian and cycling opportunities- better freight routes- road maintenance, lighting and car parks

HousingHousing

• Good sanitation and safe cooking facilities• Insulation• Avoiding of damp housing to cut down use

of energyof energy• Warmer homes for the vulnerable• Specific home adaptation, allowing older

or disabled to remain independent• Distance from contaminated & polluted

area

Environment & HealthEnvironment & Health

Main themes:• Environmental protection• Sustainable development• Environmental exposure to risks• Environmental impact assessment• Standard setting

Social InsuranceSocial Insurance

• Social insurance vs health promotion

• Social insurance sector to invest inprevention & health promotion is still new

• Social insurance for health committed topromoting health at work, includingvocational rehabilitation

WorkplaceWorkplace

• Workplace health promotion• Lifestyles• Stress management• Labor safety:• Protection of the disabled

EducationEducation• Health education in schools (part of the curricula

• School health services

• Health promoting schools

• Creating supportive settings to influence howyoung people form relationships, make decisionsand develop their values and attitudes. Forexample actions can range from ensuring toiletsare clean to preparing children for democraticparticipation in the life of the community

Challenges in addressing inequalities in health

- adoption of equity-oriented polices and implementationprocess pose a special challenge to HiAP

- epidemiological research data on inequalities is available- but there is less research on how to tackle theseinequalities in health in terms of policies and interventions

- the health gradient approach is important (focus on acrossthe entire socioeconomic gradient or the whole populationbut not only people with the greatest health risks or needs

Adelaide Statement on healthin All Policies, April 2010

• Purpose:- Is to engage leaders and policymakers at all levels of government—local regional national andlocal, regional, national andinternational.

- It outlines the need for a new socialcontract between sectors to advancehuman development, sustainabilityand equity.

Health in All Policiesapproach, April 2010

• HiAP works best when:- a clear mandate makes joined-up government animperative;- systematic processes take account of interactionsacross sectors;across sectors;- mediation occurs across interests;- accountability, transparency and participatoryprocess are present- engagement occurs with stakeholders outside ofgovernment- practical cross-sector initiative build partnershipand trust

Joined-up Government ActionSectors andissues

Interrelationships between health and well-being

Economy andemployment

• Economic resilience and growth is stimulated by a healthy population. Healthierpeople can increase their household savings, are more productive at work, canadapt more easily to work changes, and can remain working for longer.• Work and stable employment opportunities improve health for all people acrossdifferent social groups.

Securityand justice

• Rates of violence, ill-health and injury increase in populations whose access tofood, water, housing, work opportunities and a fair justice system is poorer. As aresult, justice systems within societies have to deal with the consequences ofpoor access to these basic needspoor access to these basic needs.• The prevalence of mental illness (and associated drug and alcohol problems) isassociated with violence, crime and imprisonment.

Educationand early life

• Poor health of children or family members impedes educational attainment,reducing educational potential and abilities to solve life challenges and pursueopportunities in life.• Educational attainment for both women and men directly contributes to betterhealth and the ability to participate fully in a productive society, and createsengaged citizens.

Agricultureand food

• Food security and safety are enhanced by consideration of health in foodproduction, manufacturing, marketing and distribution through promotingconsumer confidence and ensuring more sustainable agricultural practices.• Healthy food is critical to people’s health and good food and security practiceshelp to reduce animal-to-human disease transmission, and are supportive offarming practices with positive impacts on the health of farm workers and ruralcommunities.

Infrastructure,planning andtransport

• Optimal planning for roads, transport and housing requires the consideration ofhealth impacts as this can reduce environmentally costly emissions, and improve thecapacity of transport networks and their efficiency with moving people, goods andservices.• Better transport opportunities, including cycling and walking opportunities, buildsafer and more livable communities, and reduce environmental degradation,enhancing health.

Environmentsand sustainability

• Optimizing the use of natural resources and promoting sustainability can be bestachieved through policies that influence population consumption patterns, which canalso enhance human health.• Globally, a quarter of all preventable illnesses are the result of the environmentalconditions in which people live.

Housing and • Housing design and infrastructure planning that take account of health and well-Housing andcommunityservices

Housing design and infrastructure planning that take account of health and wellbeing (e.g. insulation, ventilation, public spaces, refuse removal, etc.) and involvethe community can improve social cohesion and support for development projects.• Well-designed, accessible housing and adequate community services address someof the most fundamental determinants of health for disadvantaged individuals andcommunities.

Land andculture

• Improved access to land can support improvements in health and well-being forIndigenous peoples as Indigenous peoples’ health and well-being are spiritually andculturally bound to a profound sense of belonging to land and country.• Improvements in Indigenous health can strengthen communities and culturalidentity, improve citizen participation and support the maintenance of biodiversity.

ConclusionConclusion• HiAP is an essential approach in improving population’s

health• There is a need to focus on those factors outside the health

sector that create, maintain and protect health• HiAP is a complex process and success should not be

presumed to be easypresumed to be easy• Growing health inequalities are a common concern of our

region• Action and implementation of HiAP is dependent on the

availability and existence of human resources andknowledge of public health issues

• Policy-makers, government institutions including NGOs’support is prerequisite for action on HiAP

Thank you!!!