XI HIA International Conference - In Times of Crisis, Healthier Ways 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 Simpson European Office for Investment for Health and Development World Health Organization, Regional Office for Europe Venice

XI HIA International Conference - In Times of Crisis, Healthier Ways April, Granada 3 Lessons Concept Context

Public Health in a fast changing world… Granada 2011

XI HIA International Conference - In Times of Crisis, Healthier Ways April, Granada Climate change Source: Climate Change 2007: The Physical Science Basis

XI HIA International Conference - In Times of Crisis, Healthier Ways April, Granada A world of urbanized people Rurale Urbana Source: World Urbanisation Prospects | 2005 Revision

XI HIA International Conference - In Times of Crisis, Healthier Ways April, Granada 1 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 April, Granada A fast changing context for health

XI HIA International Conference - In Times of Crisis, Healthier Ways April, Granada Issues 3 Lessons Concept Context

XI HIA International Conference - In Times of Crisis, Healthier Ways 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 April, Granada Adelaide Statement on Health in All Policies moving towards a shared governance for health and well-being

XI HIA International Conference - In Times of Crisis, Healthier Ways 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 April, Granada Issues 3 Lessons Concept Context

XI HIA International Conference - In Times of Crisis, Healthier Ways 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 April, Granada In-depth analysis of implementation

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

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