International Network of Health Promotion Foundations Capacity Building – sustainable financing and infrastructures for HP

International Network of Health Promotion Foundations

Capacity Building – sustainable financing and infrastructures for HP

www.hpfoundations.net


Infrastructure for health promotion investment: models for financing HPgovernment based approach within ministry public bodies closely linked to government health promotion foundations private foundation

ThaiHealth

Health Scotland Austrian HPF DoHA ChagnonAustralia Foundation

Colin Sindall: Department of Health & Ageing, Australia

Graham Robertson: Health Scotland (former CEO)

Krissada Raungarreerat: ThaiHealth

Rainer Christ: Austrian Health Promotion Foundation

Diane Le May: Quebec en Forme


What do Health Promotion Foundations do?

– Build capacity for promoting health;– Mobilize civil society and support community actions

for health by providing resources, training and technical assistance

– Fund health promotion initiatives to promote health and prevent disease

– Build a health promotion evidence base– Work collaboratively across sectors – Advocate for health promoting policies– Address equity issues– Trial innovative programs in sensitive areas (drugs,

STIs, etc.) that may expose governments to political criticism


Characteristics of HP Foundations Characteristics of HP Foundations

• Budget Stability:Budget Stability: funding is enshrined in legislation, can funding is enshrined in legislation, can plan and implement long term programmesplan and implement long term programmes

• Independent Operation: Independent Operation: operate WITH, but not AS operate WITH, but not AS government: supporting government priorities and government: supporting government priorities and direction.direction.

• No Bureaucratic Constraints:No Bureaucratic Constraints: quickly react to quickly react to emerging needsemerging needs

• Multi-Sectoral: aMulti-Sectoral: across a range of government departments, cross a range of government departments, nongovernmental and community-based organizationsnongovernmental and community-based organizations

[1] The Establishment and Use of Dedicates taxes for Health. WHO WPRO 2004[2 ] INHPF (http://www.hpfoundations.net) Access 2009-04-07[3] Shaping the future of health promotion: priorities for action, IUHPE CCHPC 2007[4] Infrastructures to promote health: the art of the possible, Moodie et al

[1] The Establishment and Use of Dedicates taxes for Health. WHO WPRO 2004[2 ] INHPF (http://www.hpfoundations.net) Access 2009-04-07[3] Shaping the future of health promotion: priorities for action, IUHPE CCHPC 2007[4] Infrastructures to promote health: the art of the possible, Moodie et al

http://www.hp-foundations.net/DynamicPage.aspx?menuId=45

http://www.hp-foundations.net/DynamicPage.aspx?menuId=45


How are Health Promotion Foundations funded?

Through a variety of methods: – Earmarked taxes

• Tobacco and / or Alcohol tax ThaiHealth (2% each)– Fiscal adjustments

• Austria (value added tax)– Appropriation from Treasury budgets

• VicHealth, Healthway (Australian HPFs) Malaysian Health Promotion Board

– Levy on health / sickness insurance• Switzerland : x Euro/insured person/year

Health promotion financing and organisation in Australia

Colin SindallSenior Adviser

Population Health DivisionDepartment of Health and Ageing

Capacity Building – sustainable financing and infrastructures for Health Promotion

Federal system of government with health responsibilities shared between Australian (Commonwealth) government + 6 states + 2 territories.

National responsibility for health promotion and disease prevention sits with the Australian Government Department of Health and Ageing, but states undertake significant proportion of program delivery; however, the mix is changing.

Australian Government provides largest share of total public health funding (64%), but states incur nearly three quarters (73.9%) of total public health expenditure.

Funding for public health (includes health promotion, health protection and preventive health services such as screening ) appropriated from consolidated revenue as part of the overall health portfolio budget.

Between 1999–00 and 2007–08 public health expenditure increased by around 78% in real terms, averaging 7.4% pa. Total 2007-08 = $2.2 billion; about $100 per head.

Reform commitments of current government and recent agreements by COAG (Council of Australian Governments, the peak intergovernmental forum of First Ministers, chaired by PM) have seen significant injections of new funding.

Major structural reform of health system underway: PHC reforms important for HP. Two states have HP foundations: currently no national equivalent, but legislation has

been introduced to create National Prevention Agency.

Context

Investing in prevention

The 2009-10 Budget delivers on the Rudd Government’s commitment at COAG to fund the single largest investment ever made in health promotion in Australia – focused on tackling the health problems caused by tobacco, obesity and excessive consumption of alcohol.

In partnership with the states and territories, the Australian Government will invest $872.1 million over six years in preventing lifestyle risks that cause chronic disease.

EXTRACT - MINISTER’S MEDIA RELEASE, 12 May 2009

COAG National Reform Agenda: a basis for sustainable HP?

1. COMPETITION

3. HUMAN CAPITAL

Healthier, better skilled and more motivated

workforce2. REGULATION

Health

Education & Training

Work Incentives

65+0

Develop good habits

(eg diet, exercise)

ChildcareOut of

school care

Literacy & numeracy skills

Maintain good habits

Tran

sition

in

to

wo

rking

life

Encourage & support work

Early w

ork

experien

ce

Balance work & study

Supporting re-entryBalance work & family

Maintain good health

Support ongoing participation

Balance work & leisure

Manage health

Maintain & refresh skill sets

Healthy Living

Lifelong Learning

Encouraging & Supporting Work

Early ch

ildh

oo

d d

evelop

men

t

Life Cycle

Demographic ageingChronic disease (& MH)Health system pressuresSocial inclusion

Source: Adapted from Victorian Department of Premier and Cabinet

HEALTH REFORM

Sustainable financing : opportunities, challenges, threats

Case for investment in “prevention” generally well supported in Australia, but funding from consolidated revenue always subject to decisions of government of the day and state of the economy.

Hypothecation of funding (eg from “sin taxes) historically not supported by central economic agencies at national level.

However, government’s recent increase in tax on alcopops (pre-mixed alcoholic drinks) enabled a portion of the revenue derived from the excise to support the funding of the COAG Partnership Agreement on Preventive Health; and announcement of a $50 million package of additional measures under the National Binge Drinking Strategy.

The government has stated that all of the revenue derived from the recent 25 per cent increase in tobacco excise will be dedicated to the new National Health and Hospitals Network Fund.

Legislation for proposed Australian National Preventive Health Agency (“National Prevention Agency”) enables the Agency to establish and operate a “Special Account” which would allow it to receive funding from different sources, including state governments.

Current funding allocated for Agency is $132m over four years.

Agency legislation may not passed.

Capacity building and sustainable financing

Graham Robertson

Public bodies closely linked to government

NHS Health Scotland

• Status: a national special health board, part of the National Health Service in Scotland

• Primary focus: to work with local NHS Boards and health improvement partners to develop and implement public health improvement and health inequalities programmes

NHS Health Scotland Funding

• Direct from government as an allocation within NHS budget overall

• Mixture of core (recurring) and non-core (project) funding

• 2010/11: £27m

Implications

Strengths• Part of whole system• (Relatively) secure funding• Efficiency and value added• Integrated delivery

Weaknesses• Topic-based funding• Mismatch between national and

local priorities• Perception of NHS domination• Bureaucracy

Opportunities• Access to local

capacity/resources• Access to government and

opportunity to influence policy

Threats• Public sector funding cuts• Visibility of contribution• Time-lag for impact

Set up by the Health Promotion Act 2001

Funded by an earmarked tax, 2% of tobacco and alcohol excise tax

Governing Board consists of experts and officials, chaired by the Prime Minister

Overview: ThaiHealth Overview: ThaiHealth

ThaiHealth Budget (2008) ThaiHealth Budget (2008)

16

GDP Thailad 240 Billion $

Total Gov. Budget 52.8 Billion

$ Gov. Health Budget 4.3

Billion $ ThaiHealth Budget 80 ThaiHealth Budget 80

million $ million $

(Less than 2% Gov. Health (Less than 2% Gov. Health

Budget) Budget)

Why the ThaiHealth Why the ThaiHealth ModelModel

Win-Win financing model by using the surcharge sin tax from harmful products to promote healthy people

The secured funding for the long-term and innovative health promotion initiatives

To mobilize a range of sectors to work collaboratively and flexibly

Obstacles & ChallengesObstacles & Challenges

Obstacles:Independence from political interferenceThreats from opposition industries (e.g.

tobacco, alcohol)

Challenges:Use health promotion influence the

national direction towards sustainable development

Building capacity and competencies of our various partners

Austrian Health Promotion FoundationAustrian Health Promotion Foundation

Austrian Health Promotion Foundation

Health Promotion Act, 1998Project fundingNational competence center for HPInformation and awareness raising

Financing model

Population: 8.336.549 (2008)

Funds: 7.250.000 Euro annually 9.113.250 USD (1,09 USD per capita)

Budget money (value added tax)

Relationship to Government and NGOs

Government:Board 15 Members representing various sectors and level of administration, health care and insurance sector, presided by the MOHAgreement on priorities (workplans)

NGOs:carry out the work in the field,get grants, are trained, consulted...


International Network of Health Promotion FoundationsQuébec en Forme

Join the movement

National partnersGroup of regional partnersGroup of local partners

Organigram

Fondation Lucie et André Chagnon

Governement of Québec

Fund in promotion of healthy lifestyles480 millions $ over 10 years

Mobilization projects Promotion projects

25 %

75 %

Public Health Agency of Canada

1,3M$ (2008-2010)

How it became a reality

The good idea at the right moment…

Pilot scheme of partnership between la Fondation Lucie et André Chagnon and 3 ministries of the Government of Québec aiming to give access to physical activity and sportive programs to the youth between 4 and 12 years of age in underprivileged environments.

Governmental Action Plan 2006-2012 on promotion of healthy lifestyles and prevention of weight problems

Act creating the Fund for promotion of healthy lifestyles (June 2007)

Politique-cadre for healthy eating habits and an active lifestyle (2007)

Public Health Act (revised August 2007)

Mission

To contribute to the adoption and upholding of

an active lifestyle and healthy eating habits by

Québec Youth, from birth to age 17 inclusively.

What we do

What we want to achieve

To see all concerned actors of Quebec society to create environments favouring the adoption and the upholding of an active lifestyle and healthy

eating habits.

Vision

Meaning :

Be a catalyst rather than an operator; increase efficiency of ressources and ensure the sustainability of actions.


Infrastructure for health promotion investment: models for financing HPgovernment based approach within ministry public bodies closely linked to government health promotion foundations private foundation

ThaiHealth

Health Scotland Austrian HPF DoHA ChagnonAustralia Foundation

Colin Sindall: Department of Health & Ageing, Australia

Graham Robertson: Health Scotland (former CEO)

Krissada Raungarreerat: ThaiHealth

Rainer Christ: Austrian Health Promotion Foundation

Diane Le May: Quebec en Forme

Advantages and disadvantages of different organisational models The Australian model for health promotion has generally worked well, although with room for

improvement. Location of health promotion responsibilities within the national health ministry has enabled a strong connection with the wider health and public policy agenda, and to the legislative, regulatory and fiscal levers of government.

The federal system has allowed for a considerable degree of flexibility and innovation at the state level and opportunities for learning. However, this has come at the cost of some fragmentation of effort and inconsistency in program delivery.

The proposed Prevention Agency would add value to the current health promotion environment by eg (a) consolidating social marketing functions; (b) providing a central authoritative source of evidence-based advice and recommendations for the Commonwealth Minister, for the Health Ministers Conference, for non-health ministries and for local government; (c) providing a national mechanism for collation and analysis of various sources of information, including evaluations of interventions; (d) supporting and building partnerships with other agencies (including state health promotion agencies, research groups, NGOs ) and sectors; (e) developing and promoting national standards, codes of practice and guidelines, and (f) supporting primary health organisations to deliver regional and community based health promotion programs.

With a strong relationship between the health department and the Agency, the advantages of both models - combining the flexibility and technical capacity provided by an Agency with the policy capacity and administrative expertise of government - might be realised.

Enjeux

- Perception of a Private foundation’s intervention in the interventions usually

taken by the state.

- Reactions of organisms and networks who would have prefered that the state

would directly deposit them the money.

- Silo and top-down thinking of different networks.

- Over-consultation and the pressure put on local actors

- Mobilization strategy of local actors vs the impacts on an active lifestyle and

healthy eating habits.



Capacity Building – sustainable financing and infrastructures for HP

www.hpfoundations.net

Documents

International Network of Health Promotion Foundations Capacity Building – sustainable financing and infrastructures for HP