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Tobacco-tax based health promotion foundations
Burke FishburnTechnical AdviserInternational 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…
“…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
+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 agencyCan 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 agencyCan receive funding from other sourcesFunds 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 http://www.hpfoundations.net Economic rationale
http://www.hpfoundations.net/why-health-promotion/economic-rationale-health-promotion
Key features of HPFs http://www.hpfoundations.net/about-hp-foundations/key-features-of-hpf
General roles http://www.hpfoundations.net/about-hp-foundations/what-can-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
http://www.hpfoundations.net/about-hp-foundations/legislation-for-hpf
Funding http://www.hpfoundations.net/about-hp-foundations/sources-of-funding
+VicHealth
VicHealth http://www.vichealth.vic.gov.au/ The story of VicHealth
http://www.vichealth.vic.gov.au/en/About-VicHealth/Story-of-VicHealth.aspx
VicHealth Funding model http://www.vichealth.vic.gov.au/~/media/ResourceCentre/PublicationsandResources/General/Fact Sheet_VicHealth Funding Model.ashx
+ThaiHealth
ThaiHealth Promotion Foundation http://en.thaihealth.or.th/ Origin of ThaiHealth
http://en.thaihealth.or.th/resource-center/reports/origin Master Plan 2010-2012
http://en.thaihealth.or.th/resource-center/reports/masterplan
+Healthway
Healthway (Australia) http://www.healthway.wa.gov.au/ Strategic Plan 2008-2011
http://www.healthway.wa.gov.au/default.aspx?MenuID=485 Corporate Governance
http://www.healthway.wa.gov.au/default.aspx?MenuID=675 Best Practices in Tobacco Control: Earmarked Tobacco Taxes
and the Role of the Western Australian Health Promotion Foundation (Healthway) http://www.who.int/tobacco/training/success_stories/en/best_practices_western_australia.pdf
+Others
Malaysian Health Promotion Board http://www.healthpromo.gov.my/
Austrian Health Promotion Foundation (Fonds Gesundes Österreic) http://www.fgoe.org/welcome-to-fond-gesundes-oesterreich?set_language=en&cl=en