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XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
Plenary Session 1 - Developing HiAP/HIA to reduce Health Inequalities in the context of current systemic crisis
Granada 14 April 2011
The Need to Strengthen Health Governance to address the SDH and related Health
Inequities: Lessons from Europe
Erio Ziglio & Sarah SimpsonEuropean Office for Investment for Health and Development
World Health Organization, Regional Office for EuropeVenice
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
3 LessonsConceptContext
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
Climate change
Source: Climate Change 2007: The Physical Science Basishttp://www.ipcc.ch/pdf/assessment-report/ar4/wg1/ar4-wg1-chapter10.pdf
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
A world of urbanized people
Rurale
Urbana
Source: World Urbanisation Prospects | 2005 Revision http://www.un.org/esa/population/publications/WUP2005/2005wup.htm
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada1
By next time we are going to meet…There will be more people over 65 than under 5
Source: World Population Prospects: The 1996 Revision, Annex 2 (Low-Variant Projection) UN Population Division
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
A fast changing context for health
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
Issues3 LessonsConceptContext
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
“Governance is about how governments and other social organizations interact, how they relate to citizens, and how decisions are taken in a complex and globalized world”
WHO Study on Governance by Professor Kickbusch
Source: Institute on Governance, Ottawa Policy Brief 15, 2003.
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
Adelaide Statement on Health in All Policiesmoving towards a shared governance for health and well-being
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
“Governance principles, institutional arrangements and delivery instruments, including how progress is monitored and how accountability is defined and managed”
In HIA and in making HiAP working there is a need to better understand:
Improved and more specific knowledge about these arrangements.
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
Issues3 LessonsConceptContext
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
• What are the challenges of governance in different country contexts?
• What are the core elements that construct good governance?
• What promising practices are emerging in Europe?
• What tools can be used to appraise and strengthen governance capacity in countries?
Key questions/issues from our work
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
In-depth analysis of implementation
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
Sub-national level experiences Slovenia Czech Republic United Kingdom
MURA Project Pomurje
Liberec
South Moravia
South Bohemia
North West Region of England
Italy
Tuscany
Veneto
Friuli Venezia Giulia
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
The issue of health inequities needs to be a whole-of-government priority to be addressed through a coherent set of policies and interventions on a scale appropriate to the trends and magnitude of the problem in the country
The need for good governance
Source: http://www.scotland.gov.uk
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
• What trends can we identify in relation to governance for SDH/HI?
• What factors determine whether or not SDH/HI are on the agenda?
• What factors are associated with governance principles such as ‘whole of government approach or “policy consistency” among different levels of policy-making?
1. Analyse the context
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
2. A tool to assess and strengthen governance capacity
A. Sustained policy commitment
B. Robust and equity oriented Health System
C. Active intersectoral working
D. Sustained funding mechanism
E. A high priority for health
F. Social capital and cohesion for health
G. Public engagement and community participation
H. Accountability for health inequities
I. Health intelligence
J. Monitoring of system performance
K. Communication and advocacy
L. Other according to country context
XI HIA International Conference - In Times of Crisis, Healthier Ways
14-15 April, Granada
3. Know the different levels of governance
Joint new policy
Adjusted + more efficient sectoral policies
More efficient sectoral policies
Cooperation
Coordination
Integrated Policies
Source: Adapted from Meijers E, Stead D. Policy integration: what does it mean and how can it be achieved? A multi-disciplinary review. Delft University of Technology OTB Research Institute fir housing, Urban and Mobility Studies.