1. 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

2. 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

3. 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

4. Concerted Action on Health: future prospects4
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
: 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

5. Going beyond HIA… a government policy5
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

6. Other Sectors and Health: a complex reality to document6
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

7. Developing an intersectoral policy means working together from the start7
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

8. 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

9. Conditions for Success9
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

10. 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

11. For more information 11 11