Health in all Policies Lessons learned from supporting municipalities in the Netherlands Marije van Koperen Sarah Pos 10 October 2008 HIA 2008, Liverpool

Health in all policies After Health Education (60 and 70’s) and Local Health Promotion or the Community Approach (80 and 90’s) we are entering a third stage: Health in all Policies Definition: Policy outside the strict domain of public health, but aiming at health promotion or avoiding health damage A practical and realistic way to implement the Ottawa Charter and the Healthy Cities principles

Features health in all policies Co-operation between public health and one or more other sectors investing in sectors outside Public Health Aiming at influencing one or more determinants of health Participating the local government and others (citizens, institutions, industries) Policy, not projects Sustainable

The revised Dutch Prevention Act (2003) States: all 443 Dutch municipalities to produce a policy paper every four years on health policy. In this policy paper –the municipalities give insight in the local health situation, –describe their health policies and interventions and –explore the health effects of policies outside public health. Health Inspection

Example 1 Limburg: Tackling overweight in all policies

Limburg: tackling Overweight in all policies Conference May 2006: tackling overweight is priority 1; use an integrated approach Autumn 2006: Masterclasses by NIGZ on integrated health policy and a training in three instruments facilitating this policy: –Determinants and Policy Screening –Quick Policy Scan –Health Impact Assessment April 2007: a formal meeting with certificates distributed 9 municipalities decided to join, participating policy makers of the municipalities, health promotion officers of the RPHS and NIGZ.

The Landgraaf example The idea Make a health test for urban planning projects Implementation Project group with Urban Planning, Public Health, the Regional Public Health Service and NIGZ Health Impact Assessment on a planned road around a neighbourhood Conclusion: the direct factors influencing health are taken into account, not the factors influencing people's life styles So these indirect factors should be part of the health test on urban planning (like the influence of bicycle paths and green spaces on the activity of children)

The Heerlen example The idea Overweight is concentrated in the low educated groups and especially in the group of long term unemployed Implementation Talks with Social Affairs of the municipality of Heerlen about –the two way relations between health and socio economic status –the perspectives of physical activity for re- integration Now plans for re-integration projects based on physical activity and for a course on healthy but payable food

Example 2 Rivierenland: Reduce health Inequalities with HiAP

Rivierenland aim Make a regional plan to reduce health inequalities in 9 municipalities (priority #1, January 2007) Keywords: sustainable all policies integrated support building multiple health themes

Rivierenland Implementation Spring 2007: Agreement RPHS and top management of the municipalities Autumn 2007: Master Class by NIGZ on health in all policies and a training in three instruments facilitating this policy – all municipalities/ selected relevant policies – health promotion officers of the RPHS and NIGZ NIGZ Quickscan (screening, scoping, appraisal) Sept 2007: Forming of integrated workgroups per municipality Agreement on health theme and/or process goal Use of one of the HiAP instruments Involvement of regional organisations January 2008: Request for regional funding

Lessons learned How tot motivate other sectors to promote health? What is the role of the municipality and the RPHS? Which level within local government is your entrance point for HIAP? Which route to HIAP works best?

How tot motivate other sectors to promote health? Solid argumentation and practical examples needed to convince other policy sectors (follow up research now undertaken) Do not approach top down, but emphasize on mutual interests Refer to personal work and living situation (keep it simple)

What is the role of the municipality and the RPHS? Clarity in role partitioning Municipality should be project leader (steering role) Changing roles, so new competences needed (change agent) A new way of working for the Regional Public Health Service, became part of their regular work

Entrance point for HIAP Window of opportunity Start with the most motivated person –Sometimes that’s an alderman, in other situations its a civil servant. Commitment and mandates needed at all levels (political, managerial, work floor) Top down and bottom up

Best route to HIAP Take the time to create enough support Knowledge building on HiAP process and goals Gain more in-depth knowledge in other sectors Find win-win situations Evaluate during process Just act!

Contactpersonen Mieke Steenbakkers, RPHS Zuid Limburg Rivierenland NIGZ Marije van Koperen, Sarah Pos