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

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

3. Global mandates –
2011
2014 WHA Resolution
2008
2013 Global Conference on Health Promotion
2006
2011
Rio Political Declaration on Social Determinants of Health
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
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

4. Commission on Social Determinants of Health (2005-2008)

5. 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

6. 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

7. 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

8. 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.

9. 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.

10. 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 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!

11. Country Action

12. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. Population groups, diseases, health and welfare systems

20. 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

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

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

23. 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

24. Proof of concept – networks, tools to assist

25. 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

26. 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

27. 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

28. 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

29. 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

30. Thank you!