Beyond Health Impact Assessment: a government policy for health and well-being Dr. Alain Poirier, National Public Health Director and Assistant Deputy Minister, Ministère de la Santé et des Services sociaux HIA Conference Granada, April 14 – 15, 2011 1 1

Health Impact Assessment (HIA): an important lever for intersectoral action Section 54 represents an explicit recognition by Québec authorities of the principle of intersectoral action and the impact on health of decisions made in other sectors HIA acts on the determinants of health by raising awareness among decision makers in other ministries of the importance of: Taking into account the significant negative impacts of their bills or draft regulations Adopting the measures needed to mitigate these impacts Highlighting potential positive impacts Adopting a section of an act is certainly a positive step but the challenge of applying it remains … 2 2

Strategy for Application of Section 54: supporting efforts made in other sectors Implementation of an intragovernmental health impact assessment mechanism Ongoing involvement of MSSS in the process (network of representatives) Production of decision-making tools adapted to the needs of users Access to relevant expertise within a reasonable time frame 2. Development and transfer of knowledge on healthy public policy Increase and consolidate interdisciplinary research capacities Support research to assess the effects before and after implementation of public policies Foster the transfer of knowledge to concerned decision makers and professionals Develop tools to support the development of healthy public policy 3 3

Concerted Action on Health: future prospects 4 Findings with regard to HIA Greater awareness-building and participation by partners and increasing integration of the process within ministries and public agencies Requests for projects other than laws and regulations However, many requests are sent in at the end of the process Some bills and draft regulations still do not include HIA An innovation that demonstrates the government’s commitment to HIA Going beyond HIA in intersectoral action on the determinants of health will require: Creating horizontal and vertical synergies so as to remove certain obstacles and take advantage of all opportunities for concerted action to foster health and well-being Progress report: Requests for Advice 2003-2011: 434 requests for advice directed to the MSSS Most of the requests were from the ministère du Conseil exécutif (Cabinet), but there had been prior involvement by the MSSS in many of them. 54% bills and regulations / 46% other initiatives (policies, strategies, action plans, project authorization certificates, funding, etc.) Primarily involved the environment, agrifood, employment and social solidarity 4

Going beyond HIA… a government policy 5 Québec has institutionalized a mechanism to influence other sectors in order to lessen the negative impact of their actions on the health and well-being of the population Section 54 of the Public Health Act A “health in all policies” strategy based on a whole-of-government approach would be an added value and: Better structure health-promoting actions by proposing a common framework for action Lead other sectors to develop policies, programs and action plans that enhance health and well-being Include other sectors in the prevention of health problems (the MSSS has had a prevention program – the NPHP – in place since 2003) The MSSS could rely on its acquired knowledge and experience to carry this project Population-based responsibility Data on health Expertise of the MSSS and the INSPQ with regard to the determinants of health Partnerships with other sectors (developed, notably, through the application of Section 54 and the NPHP) With regard to the context: The last MSSS policy for health and well-being expired in 2002. Ten years later, the actors in the network are expressing a desire to: -adopt a long-term plan -consolidate the actions taken by the system and other sectors under common goals and policy directions This would be a collective project that would mobilize the whole government, involving major and enduring changes in the management of issues related to health and well-being. It would lead to solutions to health problems through integrated policies that would transcend sectoral boundries Caution: Section 54 needs to be put into context so as not to lessen the real scope of HIA or discredit this practice. The goal is to highlight the contribution of a government policy IN ADDITION TO the HIA mechanism

Other Sectors and Health: a complex reality to document 6 Evidence-based data inform decision makers on the nature of a problem and the range of possible solutions The most effective time to use evidence-based data is during the drafting stage of a policy (Fafard, 2008) A government policy for health and well-being would address the complex reality of the determinants of health To develop such a policy, the MSSS intends to document : The impact of other sectors on health Healthy public policy measures The approach chosen by the MSSS to develop an evidence-based policy will involve: Meetings to exchange information with researchers Monographs on the determinants of health The aim of the meetings to exchange information with researchers would be to: Put forward existing knowledge on: (1) the links between health and another file (e.g. transportation) and (2) the healthy public policy measures that could be integrated into decision making in this sector Bring out the general trends Align the content The monographs on the determinants of health would be written by interdisciplinary research groups made up of experts and researchers specializing in the theme under study era-net transport.com

Developing an intersectoral policy means working together from the start 7 To discuss the content for a strong and mobilizing policy framework: Theme-based discussion forums bringing together chosen participants from the milieu concerned by the theme (managers, professionals, experts) Consultation with stakeholders from other sectors citizens experts from various fields of study actors from the MSSS and its network This process of documentation and discussion would enable the MSSS and its partners to guide the government policy on health and well-being on the basis of recent, reliable and validated evidence-based data, so as to favour the endorsement of decision makers

Taking Advantage of All Opportunities: the context also counts Decision making involves more than evidence-based data. Public policies are also developed on the basis of : the political agenda public opinion the decision maker’s past experiences precedents possible solutions and available resources crisis management This is why strategic monitoring is essential, as is taking advantage of all opportunities to foster commitment on the part of the highest government authorities with regard to a government policy for health and well-being Even when evidence-based data are available on a particular health issue, sometimes decision makers cannot or do not want to take them into account for organizational or contextual reasons (e.g. driving while using a cell phone) Evidence-based data stemming from research are sometimes used, not to guide decision making, but to justify it. Moreover, the literature suggests that evidence-based data used during the development of policies are socially constructed. (Fafard, 2008) 8 8

Conditions for Success 9 A literature review and an analysis of national and international intersectoral initiatives have brought out the conditions that would foster the success of the MSSS plan to develop a government policy: Provide strong leadership Affirm common values Point out the added value of the policy to partners Show respect for different visions and practices Have a plan and mechanisms for implementation Recognize the importance for the regional and local levels to integrate the policy Provide for follow-up Report back to all levels through formal mechanisms Themes of the national initiatives analyzed : Poverty and social exclusion Sustainable development Equality between men and women Rural life Multiethnicity (integration) International initiatives analyzed: England Finland Sweden Norway New Zealand Australia (Adelaide) 9

To sum up… Québec has adopted an HIA mechanism which represents an important lever for healthy public policies The strategy for application of Section 54 of the Public Health Act makes it possible to assist and support actors in other sectors A government policy for health and well-being would provide a broader framework that would strengthen government interventions to foster health Such a policy must be based on rigorous documentation and take other sectors into account Strategic monitoring is essential, as is taking advantage of all opportunities to move forward on a government draft policy for health and well-being 10 10

For more information http://www.msss.gouv.qc.ca 11 11