XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

Plenary Session 1 - Developing HiAP/HIA to reduce Health Inequalities in the context of current systemic crisis

Granada 14 April 2011

The Need to Strengthen Health Governance to address the SDH and related Health

Inequities: Lessons from Europe

Erio Ziglio & Sarah SimpsonEuropean Office for Investment for Health and Development

World Health Organization, Regional Office for EuropeVenice

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

3 LessonsConceptContext

Public Health in a fast changing world…

Granada 2011

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

Climate change

Source: Climate Change 2007: The Physical Science Basishttp://www.ipcc.ch/pdf/assessment-report/ar4/wg1/ar4-wg1-chapter10.pdf

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

A world of urbanized people

Rurale

Urbana

Source: World Urbanisation Prospects | 2005 Revision http://www.un.org/esa/population/publications/WUP2005/2005wup.htm

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada1

By next time we are going to meet…There will be more people over 65 than under 5

Source: World Population Prospects: The 1996 Revision, Annex 2 (Low-Variant Projection) UN Population Division

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

A fast changing context for health

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

Issues3 LessonsConceptContext

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

“Governance is about how governments and other social organizations interact, how they relate to citizens, and how decisions are taken in a complex and globalized world”

WHO Study on Governance by Professor Kickbusch

Source: Institute on Governance, Ottawa Policy Brief 15, 2003.

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

Adelaide Statement on Health in All Policiesmoving towards a shared governance for health and well-being

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

“Governance principles, institutional arrangements and delivery instruments, including how progress is monitored and how accountability is defined and managed”

In HIA and in making HiAP working there is a need to better understand:

Improved and more specific knowledge about these arrangements.

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

Issues3 LessonsConceptContext

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

• What are the challenges of governance in different country contexts?

• What are the core elements that construct good governance?

• What promising practices are emerging in Europe?

• What tools can be used to appraise and strengthen governance capacity in countries?

Key questions/issues from our work

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

In-depth analysis of implementation

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

Sub-national level experiences Slovenia Czech Republic United Kingdom

MURA Project Pomurje

Liberec

South Moravia

South Bohemia

North West Region of England

Italy

Tuscany

Veneto

Friuli Venezia Giulia

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

The issue of health inequities needs to be a whole-of-government priority to be addressed through a coherent set of policies and interventions on a scale appropriate to the trends and magnitude of the problem in the country

The need for good governance

Source: http://www.scotland.gov.uk

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

• What trends can we identify in relation to governance for SDH/HI?

• What factors determine whether or not SDH/HI are on the agenda?

• What factors are associated with governance principles such as ‘whole of government approach or “policy consistency” among different levels of policy-making?

1. Analyse the context

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

2. A tool to assess and strengthen governance capacity

A. Sustained policy commitment

B. Robust and equity oriented Health System

C. Active intersectoral working

D. Sustained funding mechanism

E. A high priority for health

F. Social capital and cohesion for health

G. Public engagement and community participation

H. Accountability for health inequities

I. Health intelligence

J. Monitoring of system performance

K. Communication and advocacy

L. Other according to country context

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

3. Know the different levels of governance

Joint new policy

Adjusted + more efficient sectoral policies

More efficient sectoral policies

Cooperation

Coordination

Integrated Policies

Source: Adapted from Meijers E, Stead D. Policy integration: what does it mean and how can it be achieved? A multi-disciplinary review. Delft University of Technology OTB Research Institute fir housing, Urban and Mobility Studies.

XI HIA International Conference - In Times of Crisis, Healthier Ways

14-15 April, Granada

Give him charity, girl, as there is nothing worse in life than being blind in Granada.

Francisco Alarcón de Icaza, Venezuelian writter.

THANK YOU