Ottawa challenges we face

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Ottawa challenges we face

• Ilona Kickbusch
• Open University London 2006

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20 Years Ottawa Charter
Towards a new public health..
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Towards a new public health

• We are challenged to develop a public health
  approach that responds to the globalized world
  and its political, social and economic
  ramifications. The challenge is as large as when
  public health was first developed.

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Better population health depends on

• Making health everybody's business
• Ensuring equity.
• Making the healthy choice the easier choice
• Ensuring sustainability.

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Expansion processes of the health society

• the expansion of the do-ability of health
  something can be done, there is always more
  health
• the expansion of the territory of health into an
  increasing array of personal, social and
  political spaces health is everywhere
• the expansion of risk and reflexivity every
  choice is potentially also a choice for or
  against health

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Navigating the health society

• In almost every aspect of our lives we are
  faced with questions and decisions about health.

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But

• UK One in five people has problems
• with the basic skills needed to
• understand simple information
• that could lead to better health,
• 15 of adult population have
• low health literacy
• Canada 22 of Canadians are
• unable to read a medicine label
• and calculate amounts of medicine
• US Institute of Medicine 90 MILLION AMERICANS
  (NEARLY 1 IN 2 ADULTS) DO NOT UNDERSTAND BASIC
  HEALTH INFORMATION

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How to create health

• Health is created
• in the context of
• everyday life
• where people
• live, love,
• work and play.
• Ottawa Charter 1986
• Google?shop?travel?

go
google
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The new public health

• Health is created
• in the context of
• everyday life
• where people
• live, love,
• work and play.
• Ottawa Charter

• Key components of change

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1. Health and longevity drive society
We need to adapt health and welfare Policies to
achieve the longevity dividend
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2. Consumer society Health as a global market
force

• Commercialization and Privatization health as a
  product
• Health as a key global market
• Countries compete on health

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Increasing number of consumer products and choices
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Increasing sources of health information
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Increasing choices in products and treatments
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Increasing provider choices
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Empowerment in the consumer society

• Citizens have a right to
• health competencies,
• patient competencies,
• consumer competencies,
• citizen competencies
• in the context of supportive environments
• Health Literacy is a critical empowerment
  strategy to increase peoples control over their
  health, their ability to seekout information and
  their ability to take responsibility.
• Kickbusch/Maag 2005

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3. The globalizaton of everyday life drives health

• The global
• Risks in the 21st century are transnational and
  all attempts to control them lead into the
  international arena

• The local
• Global risk production is localized through the
  globalization of everyday life
• COGNITIVE
• SPATIAL
• TEMPORAL

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Address the trans boundary scapes of health in a
global world
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Healthscapes Food - Drink
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Healthscape virtual realities

• "The Internet is unlike anything we've seen
  before," says David Greenfield, PhD, founder of
  the Center for Internet Studies
  (www.virtual-addiction.com). "It's a socially
  connecting device that's socially isolating at
  the same time."

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Healthscape Fashion industry

• New Regulations in Madrid
• A model of 1,76 m. must not weigh less than 56
  Kilogramm. That is a Body-Mass-Index of 18.0 and
  is already below the value assigned to a healthy
  body weight.Naomi Campbell 1,77 m. and weighs
  51 Kilo. That means a BMI of 16.

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Healthscapes womens mobility

• Migration and
• increased mobility of women
• New slave markets
• Forced prostitution
• Domestic workers
• Health workers
• Low paid service work

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4. The policy arenas and actors shift

• Foreign policy
• Security policy
• Economic policy
• Trade policy
• Geopolitics

• From the ministries of health to

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Consider the new health actors
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Consider the new health actors
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Consider the new health actors
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Consider the new health actors Patient
organizations
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Health policy becomes an open system

• Health policy in the 21st century is
  transnational and attempts to control risks by
  linking the local, national and the global
  policy arenas

• Health policy in the 21st century is part of all
  sectors and attempts to create health through new
  types of policy networks

Healthy public policy
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• Open systems of governance
• Finnish European Union Presidency
• Ideally health agenda owned by other sectors
• Empowering ministries of health
• Political will
• Governance mechanisms

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Open systems of governance

• National global health strategies to counter
  from a national standpoint, the threats to global
  health
• Problems which directly or indirectly threaten
  populations
• Contribution to global problems
• Contributions to global solutions
• National consensus on principles, values, intent
  and directions

• Foreign policy
• Security policy
• Economic policy
• Trade policy
• Demographic Geopolitics

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..a new global POLITICAL ECOSYSTEM
MSF
CLINTON
BONO
PHA
WEF
World Bank
150 PPPH
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5. The Sustainability Challenge
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Ecological footprint
of the health system

• What amount of ressources does it take to create
  health?

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Ecological footprint
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The new dynamics of health

• We must begin not end with the political and
  social determinants of health

• Health is a determinant
• Health is an investment
• Health is a resource
• Health is a human right
• Health is a driving force in modern societies

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Political determinants..

• The deliberation of major health issues
  and major health determinants in fora to which
  the public health community has little or no
  access and is not prepared for.

What kind of Ministers of Health??????????
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Political advocacy Have you voted for health
today?

• Public health actors must work systematically
  with political decision makers and
  parliamentarians at all levels of governance
  national, European and global.
• Create new types of public health forums

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Health Promotion in a globalized world

• health as
• a global public good
• a key component of collective human security
• a key factor of good global governance
• responsible business practice and social
  responsibility
• global citizenship and human rights.

• Healthy public policy
• Supportive environments
• Community action
• Personal skills
• Reorient health services
• Ottawa Charter

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European nations

• should ensure through cooperation a common high
  level of health protection and health rights for
  all citizens wherever they live, love work and
  play (and travel, buy or google)
• from those risks and threats to their health,
  safety and well being which are beyond the
  control of individuals and communities AND NATION
  STATES
• And cannot be effectively tackled by nation
  states alone but need to be multiactor and
  multilevel (e.g. health threats, unsafe products,
  unfair commercial practices).

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The global is here not there.....
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Interdependence
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Global Governance becomes more important
MOH
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Regulatory power 1

• The renewed mandate given to Member States and
  WHO under the IHR(2005) has also increased their
  respective roles and responsibilities. In
  particular, States Parties to the IHR(2005) are
  required to develop, strengthen and maintain core
  surveillance and response capacities to detect,
  assess, notify and report public health events to
  WHO and respond to public health risks and public
  health emergencies. WHO, in turn, is to
  collaborate with States Parties to evaluate their
  public health capacities, facilitate technical
  cooperation, logistical support and the
  mobilization of financial resources for building
  capacity in surveillance and response.

• The broadened purpose and scope of the IHR(2005)
  are to "prevent, protect against, control and
  provide a public health response to the
  international spread of disease and which avoid
  unnecessary interference with international
  traffic and trade."

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Regulatory Power 2 Framework Convention Tobacco
Control 27.05.2005

• "The WHO FCTC negotiations have already unleashed
  a process that has resulted in visible
  differences at country level. The success of the
  WHO FCTC as a tool for public health will depend
  on the energy and political commitment that we
  devote to implementing it in countries in the
  coming years. A successful result will be global
  public health gains for all."
• Dr LEE Jong-wook. Director-General, World Health
  Organization 2006

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Framework Convention Tobacco Control
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Global developments Projected prevalence of
obesity in adults by 2025
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Local IMPACT

• Cost of the SARS
• epidemic to Toronto
• 12 000 lost jobs
• Cost to the local economy
• over 1 billion in 2003
• Asia
• Cost per person US 6 million (60 billion in
  costs)

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Accountability to own constituency and
global community
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Taxation

• the tax on flights from France is expected to
  generate 200 million euros a year for an
  International Drug Purchase Facility, also known
  as Unitaid.The fund will be used to bulk-buy
  medicines for countries -- mainly in Africa
• 19 pays se sont engagés à instaurer une
  contribution volontaire. 4 pays ont déjà rejoint
  la France en instaurant une contribution
  volontaire  le Chili, la Côte dIvoire, le
  Gabon, Maurice. 12 autres pays ont engagé des
  procédures interministérielles ou parlementaires
  pour ladopter.
• Passengers flying out of French airports will pay
  one euro in economy class, and 10 euros in
  business, if their destination is in the EU. For
  flights outside Europe, the surcharges are
  between four and 40 euros, depending on the class 

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Active citizenship

• Active health citizenship is a critical
  empowerment strategy in modern society a
  significant dimension of citizen, consumer and
  patients rights and dignity multi level
  dimensions

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Une démarche citoyenne mondiale