Global priorities on the Health in All Policies Approach Nicole Valentine, WHO (Geneva) Global priorities on the Health in All Policies Approach

Overview Global mandates: SDH and HiAP Current HiAP mandate 67.12 Towards a Master Global Plan for Training Priorities for implementing HiAP

Global mandates – 2011 2014 WHA Resolution 2008 2013 Global Conference on Health Promotion 2006 2011 Rio Political Declaration on Social Determinants of Health 2008 Report of the Commission Social Determinants of Health 1997 1988 C-PHC S-PHC Reforms & Minimum Packages MDG Scaling-up Equity and SDH NCDs post-2015 2006 Finnish Presidency of the European Union in 2006, Health in All Policies (HiAP) 2011 UN Political Declaration on NCDs 1986 1997 Intersectoral Action for Health- a cornerstone for health for all in the 21st century 2009 WHA Resolution Reducing Health Inequities Through Action on the Social Determinants of Health 1978 1986 World Health Organization’s Ottawa Charter for Health Promotion Ideological shifts: 70s – Decade of development: consensus on health and development 80s – “Lost Decade”, proliferation of strategies: selective PHC vs. integrated health care, district health systems and Healthy Cities 90s – Decade of Reform & Globalization: efficiency of bureaucracy and introduction of market economies in health sector; also the Water Decade and the "Washington Consensus” – IMF-WB-WTO New influence of stakeholders: UNICEF – selective application of PHC, 1979, then moved to children's rights, 1995 WB – redefines measurements of health: WDR 93 Investing in Health UNDP – introduces country strategy note & includes PHC. Effort for better UN coordination, MDGs USAID – emphasizes civil society and quality New health discipline: Health economics introduces new ways of measuring resources and health achievements, influencing design of health systems financing and efficiency measures National budgets for health: Increase as % of GDP Decrease in equitable distribution 1999 The Gothenburg consensus Paper on Health Impact Assesment 1948 1978 Alma-Ata Declaration Health for All agenda (1970s), action falters in 1980s 1988 Adelaide Recommendation on Health Public Policy Social dimensions of health affirmed in WHO Constitution (1948), downplayed during 1950s era of disease campaigns

Commission on Social Determinants of Health (2005-2008)

Rio Political Declaration on SDH (2011) Action areas: To adopt better governance for health and development To promote participation in policy-making and implementation To further orient the health sector towards reducing health inequities To strengthen global governance and collaboration To monitor progress and increase accountability

Current HiAP mandate 67.12 Health equity: “An approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity” 2013 Helsinki Statement on Health in All Polices Health equity: The absence of unfair and avoidable or remediable differences in health among groups defined socially, economically, demographically or geographically. Population health interventions: Aim to change the social context that influences health (Rose in Frohlich, 2014) HiAP an Enabler for Public Health and Health Equity

134th Session of the Executive Board in January 2014 Report prepared by the Secretariat and presented to EB 134 67th Session of the WHA, May 2014 Adopts resolution 67.12

Resolution 67.12 Urges Member States : to champion health and the promotion of health equity as a priority and take action on the social, economic and environmental determinants of health; to take steps that enable societal policies which take into account and address their impacts on health determinants, health protection, health equity and health systems functioning; to develop sustainable institutional capacity with adequate knowledge and skills in assessing health impacts of policy initiatives in all sectors; to take action to enhance health and safeguard public health interests from undue influence by any form of real, perceived or potential conflict of interest; to include relevant stakeholders in the development, implementation and monitoring of policies across sectors; to contribute to the development of the post-2015 development agenda by emphasizing that policies in sectors other than health have a significant impact on health outcomes, and by identifying synergies between health and other sector policy objectives.

Resolution 67.12 REQUESTS the WHO Director-General: to prepare a “Framework for country action across sectors for health and health equity” for adaptation to different contexts, taking into account the Helsinki statement on health in all policies; to provide guidance and technical assistance to MS in order to integrate health perspectives in non-health sector policies; to strengthen WHO’s role, capacities and knowledge resources, to give guidance and technical assistance for implementation of policies across sectors and to ensure coherence and collaboration across programmes and initiatives within WHO; to continue to work with and provide leadership for the organizations in the United Nations system, development banks, other international organizations and foundations; to report on the progress made in implementing this resolution to the Sixty-ninth World Health Assembly through the Executive Board.

1. Development of Framework for country action across sectors for health and health equity A discussion paper was developed and posted on the web from October to December 2014 for comments ( only 15 submissions received) First Draft of the Framework has been developed by the Secretariat based on the Discussion Paper and comments received First draft has been posted again on the web and is open for comments until 3 March 2015. Technical reference group (one expert per WHO region) will meet on 5-6 March 2015 to discuss latest comments and provide final recommendations Second Draft will be put together by the Secretariat and presented to WHA in May 2015 The technical reference group will meet next week. It will be chaired by Finland and WHO PND Now!

Country Action

3. Strengthen WHO’s role, capacities and knowledge resources 2. Guidance and technical assistance to Member States in order to integrate health perspectives in non-health sector policies Examples: Working with Member States for developing, implementing and monitoring “National Multisectoral Action Plans for NCD Prevention and Control” PAHO Member States endorsement of the PAHO Plan of Action for HiAP in its Directing Council in 2014 Meeting with ministers of finance regarding FCTC Health in All Policies Trainers' Meeting in Geneva: 24-26th  Master Global Plan for Training in Working Across Sectors Working with University Networks and the WHOCCs for health promotion 3. Strengthen WHO’s role, capacities and knowledge resources

Examples 4. Work with UN agencies WHO discussed the role of UN agencies in actions across sectors for health during the last UN Interagency Taskforce for the Prevention and Control of NCDs meeting in Rome in February 2015 5. Report on the progress made in implementing this resolution to the Sixty-ninth World Health Assembly through the Executive Board 67.12 OP(3)1 will be reported in May 2015

Towards a Master Global Plan for Training in Working Across Sectors Dissemination, advocacy and demand generation Facilitating networks of institutions/trainers Actively supporting rapid adaptation of Training Manual Conducting regional and country trainings Creating shared resources Fund-raising

Kickbusch Briefing Manual 2015 Underlying themes Dynamics and complexity Health Equity Framing Whole of government//society Collective impact Mutual gain, Negotiation, health diplomacy Kickbusch Briefing Manual 2015

Kickbusch Briefing Manual 2015 FOCUS: Participants Educational approach: highly participatory Learn skills – conduct stakeholder analysis, prepare policy briefs, role play situations and carry out negotiations, prepare a health impact assessment Kickbusch Briefing Manual 2015

Kickbusch Briefing Manual 2015 Mindset shift in perspective so that all actors consider improved health and wellbeing as an overarching social goal that requires shared action create a shared mental map for participants in relation to HIAP and equip them to be policy champions for HIAP and equity Kickbusch Briefing Manual 2015

Population groups, diseases, health and welfare systems

Build on successful launch E-launch on WHO Web platform on 25 Feb '15 Mission briefing HQ lunch seminar HQ Website 2 days: page visited 1590 times and 1122, unique visitors with average time spent of 4:08mn on the page. Dissemination via Equidad

Health in All Policies Trainers` Meeting 96% of participants answered survey questions (n=26)

Health in All Policies Trainers` Meeting 58 countries out of 193 WHO state members covered by participants` previous experience

Priorities for implementing HiAP Proof of concept - demonstrate feasibility and impact - and dialogue Provide concrete linkages with primary health care services and communities Clarifying health sector's role in the HiAP process, and terminology Addressing equity for health Build systems, linked to SDGs, for surveillance of trends in inequities in health determinants and health impacts

Proof of concept – networks, tools to assist

Concrete linkages to primary health care and communities Education and skills Inadequate communication with patients (due to limited interactions or time for consultations, social distance, patient-doctor collusion, etc.) Inaccurate knowledge on preventative and curative treatments (e.g. effectiveness, side-effects, guidelines, range available, how to engage in effective self-care) Working conditions High opportunity costs i.e. time lost in travelling to and using services, with implications for lost wages or need to purchase replacements for unpaid work, and lack of relevant social protection Gender equality Women’s lack of autonomy in healthcare decisions and more generally (e.g. mobility, financial autonomy, division of labour, fear of violence, abandonment or disapproval from partner) What have countries done to address social determinants of health? What is the scope of action? Discrimination (and registration) Shame, fear of discrimination or embarrassment related to health status or use of a particular treatment Accountability and registration Lack of follow-up and matching to appropriate services due to poor record-keeping, coordination and data sharing across health programmes or providers, sectors and jurisdictions

Health's role – "leadership" Describe evidence of the issue so non-health sectors can relate to it Build on concerns about using resources efficiently and sustainable economic growth Build on concerns about equity “An approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity” 2014 WHA Resolution on Contributing to Social and Economic Development

the entry point of programs or policies Driving an equity lens "How, or when, does intersectoral action or HiAP contribute to addressing social determinants of health and improving health equity?" the entry point of programs or policies explicit goals to address equity strategies for managing specific actions for progressive targeting of services within universalism. WHO Rockefeller-funded project on Supporting Regional Positions on Health in All Policies

SDGs Conserve and sustainably use the oceans, seas and marine resources for sustainable development Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, ..and reverse land degradation and halt biodiversity loss Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels Strengthen the means of implementation and revitalize the global partnership for sustainable development End poverty in all its forms everywhere End hunger, achieve food security and improved nutrition, and promote sustainable agriculture –(health)- Ensure inclusive and equitable quality education and promote life-long learning opportunities for all Achieve gender equality and empower all women and girls Ensure availability and sustainable management of water and sanitation for all Ensure access to affordable, reliable, sustainable, and modern energy for all Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation Reduce inequality within and among countries Make cities and human settlements inclusive, safe, resilient and sustainable Ensure sustainable consumption and production patterns Take urgent action to combat climate change and its impacts

Monitoring of intersectoral barriers and determinants Monitoring Health in All Policies Trends and impacts of structural determinants of health equity; what is being done to address this? Monitoring intersectoral factors influencing universal health coverage Factors contributing to incomplete coverage of health services Monitoring health equity (health and coverage outcomes) How large are health and coverage inequalities between social groups? Equity-oriented accountability between health and other sectors WHO Rockefeller-funded project

Thank you!