+ Tobacco-tax based health promotion foundations Burke Fishburn Technical Adviser International Union Against Tuberculosis & Lung Disease

+ Rationale PUBLIC HEALTH EFFICIENCY Funds spent on keeping the population healthy, versus treating the sick, could improve efficiency within the same level of resources; SOCIAL COHESION “Wellness of all” can be a rallying point for political and health sector reforms. COMMUNITIES & FAMILIES CAN CHANGE THE NORM Behavior change is a collective endeavor INVESTMENT IN HEALTH PROMOTION PAYS OFF Health promotion can yield big [short-term] returns

+ Health promotion is not…. Health Promotion ≠ Health Education (alone)

+ Health promotion is… Education Social Mobilization Advocacy

+ Health promotion is… “…the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. …Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well- being.” Ottawa Charter, developed from the 1st International Conference on Health Promotion in Ottawa, Canada in 1986

+ 5 priority HP actions 1. Build healthy public policy; 2. Create supportive environments for health; 3. Strengthen community action for health; 4. Develop personal skills; and 5. Re-orient health services.

+ HP approaches: Social determinants of health Socio-enviironmental Improve access to food, housing, income, employment, social isolation, early life, transport, addiction and education Create healthy environments Preventive Prevent initial occurrence of an illness (primary prevention); e.g. childhood immunisation programs; Stop or slow existing illness (secondary prevention); e.g. cervical screening; Reduce the re-occurrence and establishment of chronic illness (tertiary prevention), e.g. effective rehabilitation. Lifestyle/behavioral Improving behavioural risk factors, such as smoking, poor nutrition, physical inactivity and substance abuse. Focus at the individual or population level and commonly uses health education, social marketing, self-help, self-care and public policies to support healthy lifestyles.

+ HPF Characteristics Primarily fund health promotion activities Established under legislation Have long term and recurrent funding Governed by an independent Board Make decisions autonomously Allocate funds transparently and equitably Are politically non aligned Work with and across all sectors

+ What HPFs can do Provide grants Plan and implement health promotion programs Use sport and arts activities to promote health messages Support health promotion research by offering grants Carry out health promotion research Fund community development Offer an alternative source of funds to prevent sponsorship from “unhealthy products” (tobacco, alcohol, fast-food) Conduct social marketing Advocate for policy Build leadership and capacity in communities

+ HPF funding models Austria Vic Health & Healthway Malaysia Mongolia Switzerland Thailand VAT distributed by MOF Direct grant from Treasury (formerly tobacco tax) Triennial allocation from Govt based on application from Board Govt budget plus non refundable aid and contributions from other countries and orgs. 2% tobacco and alcohol tax Health insurance levy of around $ 2.25 per insured person annually 2% of alcohol and tobacco excise tax

+ HPF structures: 4 models Invisible Embedded Attached Independent

+ Invisible Location: HPF located within/under Government agency/Ministry of Health Funded: “only” by general revenues provided to agency Partners: are external to HPF and agency; partnerships are through agency

+ Embedded Location: HPF located within/under Government agency/Ministry of Health Funded: General revenues provided to agency Can receive funding from other sources Partners: are external but partnerships can be directly through HPF

+ Attached Location: HPF “attached” to government agency/Ministry of Health Funded: General revenues provided to agency Can receive funding from other sources Funds can go directly to HPF Partners: can be internalized with HPFs

+ Independent Location: HPF independent from government agency/Ministry of Health Funded: Tobacco tax+ revenue directly to HPF General revenues can be provided directly to HPF HPF can receive funding from other sources Partners: can be initiated and internalized within HPF

+ HPF governing structures Governing Board with representation from a wide range of stakeholders usually a mix of government and non- government organizations Representation from government Ministries or people with expertise in health, sport and physical activity, arts and culture, young people, local government Board members nominated for their expertise in marketing, finance, community development or research. May be political Committees or advisory panels with expertise in priority areas Staff to manage activities

+ Resources International Network of Health Promotion Foundations Economic rationale promotion/economic-rationale-health-promotionhttp:// promotion/economic-rationale-health-promotion Key features of HPFs foundations/key-features-of-hpfhttp:// foundations/key-features-of-hpf General roles health-promotion-foundations-do health-promotion-foundations-do Summaries of information on VicHealth, Healthway, Austrian Health Promotion Foundation, (FGÖ), Health Promotion Switzerland, ThaiHealth and Malaysian Health Promotion Board Legislation for-hpfhttp:// for-hpf Funding fundinghttp:// funding

+ VicHealth VicHealth The story of VicHealth VicHealth/Story-of-VicHealth.aspxhttp:// VicHealth/Story-of-VicHealth.aspx VicHealth Funding model ationsandResources/General/Fact Sheet_VicHealth Funding Model.ashx ationsandResources/General/Fact Sheet_VicHealth Funding Model.ashx

+ ThaiHealth ThaiHealth Promotion Foundation Origin of ThaiHealth center/reports/originhttp://en.thaihealth.or.th/resource- center/reports/origin Master Plan center/reports/masterplanhttp://en.thaihealth.or.th/resource- center/reports/masterplan

+ Healthway Healthway (Australia) Strategic Plan Corporate Governance Best Practices in Tobacco Control: Earmarked Tobacco Taxes and the Role of the Western Australian Health Promotion Foundation (Healthway) actices_western_australia.pdf actices_western_australia.pdf

+ Others Malaysian Health Promotion Board Austrian Health Promotion Foundation (Fonds Gesundes Österreic) oesterreich?set_language=en&cl=enhttp:// oesterreich?set_language=en&cl=en