contact : galeag @ who.int & ncd intersectoral action contact : galeag @ who.int

ncd sdh dev

threesteps sir george alleyne

specificity of purpose identification of specific resources threesteps mutuality of interest specificity of purpose identification of specific resources

sustainable development a range of interests globalisation health systems sustainable development specific populations fiscal instruments synergies with a.t.m. urban planning children, mothers food trade public policy & health systems climate change gender equity intervention points e.g. prsp education ageing

adelaide statement http://www.who.int/entity/social_determinants/hiap_statement_who_sa_final.pdf

adelaide statement tools and instruments inter-ministerial and inter-departmental committees cross-sector action teams integrated budgets and accounting cross-cutting information and evaluation systems joined-up workforce development community consultations and Citizens’ Juries partnership platforms Health Lens Analysis impact assessments legislative frameworks

http://www.health.sa.gov.au/pehs/HiAP/health-lens.htm

identifying mutual interest [example 1] ncd and tb

current trend (0.5%) extrapolated global plan | tb not eliminated by 2050 10000 current trend (0.5%) extrapolated 1000 100 global plan prediction incidence falls 5-6% per year incidence/million/yr 10 desired trend elimination target: 1 / million / year by 2050 1 1990 2000 2010 2020 2030 2040 2050

population attributable fraction selected risk factors relative risk for active tb disease weighted prevalence (22 HBCs) population attributable fraction hiv infection 8.3 1.1% 7% malnutrition 3.0 17.2% 25% diabetes 3.0 3.4% 6% alcohol use (>40g / d) 2.9 7.9% 13% active smoking 2.6 18.2% 23% indoor air pollution 1.5 71.1% 26% source: lönnroth k, raviglione m. global epidemiology of tuberculosis: prospects for control. semin respir crit care med 2008; 29: 481-491

additional tb intervention entry points improving access and early case finding: target risk populations: poor people, urban slums, vulnerable groups target "clinical risk groups": hiv, smokers, malnourished, diabetics, alcoholics risk factors: within health system managing comorbidities within ntps: hiv, smoking, nutrition, diabetes, alcohol, etc integrated management and preventive actions within phc (part of hss agenda) determinants: beyond the health system joint across priority public health conditions action within ntps: poverty reduction and improved living conditions among tb patients advocate for social change: ntps, the stop tb partnership, activists, civil society

specificity of purpose [example 2] ncd & transport

Transport: a common upstream cause of many risks to health Physical inactivity → 1.9 million deaths Traffic injuries → 1.2 million deaths Ambient air pollution → 800,000 estimated deaths in cities Climate Change → over 150,000 deaths Noise – annoyance, learning issues for children Networks of support, urban quality of life Slide by: Carlos Dora, WHO

Slide by: Carlos Dora, WHO Health sector response: disconnected, little understanding of co-benefits from policy decisions Noise TRAFFIC INJURIES PHYSICAL INACTIVITY AIR POLLUTION CLIMATE CHANGE Slide by: Carlos Dora, WHO

What are the issues identified by the other sector? Stakeholders analysis NGOs – car dependency, no support for walking and cycling or public transport Environmentalists worried about externalities Transport sector concerned with traffic congestion International agencies slow negotiations on transport and environment (OECD, UNECE) EEHC agreed to support focus on THE (Austria, Denmark, Netherlands, Switzerland...) Slide by: Carlos Dora, WHO

Why should governments act? To make optimal decisions in view of competing points of view Car and Road lobby: “Benefits outweigh the Costs, the health burden is a price societies pay for mobility and convenience they enjoy.” Health & Environment: “Healthy transport can improve public health, safeguard the environment, enhance access and the economic vitality of cities” Those using/benefiting from transport do not pay for all its costs With no intervention the level of road use will be higher than socially optimal, as the costs for society exceed the costs for the road user. Slide by: Carlos Dora, WHO

To give a voice to groups excluded from decision making Children are vulnerable to injuries, air pollution and noise, their cognitive and physical development require exploration of the neighbourhood and outdoor activity. Children and other vulnerable groups are exposed to risks from traffic but enjoy few benefits from it. These groups often do not have a voice to influence decisions. Governments need to be that voice. Slide by: Carlos Dora, WHO

To promote health equity Exposure to health risks depends on mode of transport used Need to ensure safety of people using all modes Pedestrians and cyclists do not cause pollution, contribute to reducing traffic congestion, will use health services less and be more assiduous to work, but are exposed to health risks caused by motor vehicle users (injuries, pollution) Car uses much more space per person transported Road space is limited And yet, policies are made for the car user Transport policies should focus on reducing the risks that affect the poor as a way to reduce inequalities in health and as a means of poverty reduction Slide by: Carlos Dora, WHO

Slide by: Carlos Dora, WHO Tools Scenarios Case studies Health impact assessment Evidence clearinghouse Guidance for economic assessment Performance standards Slide by: Carlos Dora, WHO

intersectoral mechanisms/instruments for implementing hiap formal consultations on e.g. legislation horizontal public health committees (legal base) ad hoc committees on specific initiatives public health reporting (with co-operation of other sectors, legal base) formal communication between sectors (e.g. bilateral meetings of permanent secretaries) informal contacts at desk level impact assessment (integrated/health) Slide by: Timo Ståhl, THL

ncd thank you sdh dev