Implementing Health in All Policies into the regional agenda

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Implementing Health in All Policies into the
regional agenda

• Dr Matthias Wismar
• Senior Health Policy Analyst

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Overview

• What is HiAP?
• Live expectancy, social determinants of health
  and policies
• Why implementing HiAP on the regional and local
  level?
• HiAP in the multi-layer system, regional and
  local aspects, regional and local variations in
  the social determinants of health
• How implementing HiAP?
• Policy formulation, tools for inter-sectoral
  dialogue and collaboration, integration into
  health services

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Life expectancy in men 1978-2007What is HiAP?
Source HFA database
80
Sweden
78
76
Members before 2004
74
13.5 life years
72
Members since 2004 and 2007
life years
70
7 life years
Romania
Estonia
68
Latvia
66
Lithuania
64
Transition
62
Alcohol control policy
60
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
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Policies and social determinants of healthWhat
is HiAP?

• The entry point for Health in All Policies
• The so called determinants of health influence
  the health of the population and individuals
• Changes in the determinants may result in changes
  in the health of the population and individuals
• Some determinants are amenable to policy changes!

(Dahlgren and Whitehead 1991)
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?
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HiAP in the multi-layer systemWhy implementing
HiAP on the regional and local level?
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Regioanl and local aspects of agrigultural and
nutrition policy
Which member states are eating healthy diets
according to the WHO guidelines?
(Lobstein 2004)
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Regional and local variations in the social
determiants of health
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Regional and local variations in the social
determiants of health
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• Objective 1 to promote the development and
  structural adjustment of regions whose
  development is lagging behind
• Objective 2 to support the economic and social
  conversion of areas experiencing structural
  difficulties

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2nd Styra (Austria) state health conferenceHow
implementing HiAP policy formulation
HiAP is a governance task!
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National health policy formulation (31. Dec. 2004)
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Regional and local health policy formulation(31
Dec 2004)
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Excerting influence inter-sectoral dialogue

• The Finnish health policy reporting (Stahl et al.
  2006)
• Andalucian intersectoral policy dialogue on
  health impact assessement (Feb 2008)
• The Dutch intersectoral policy dialogue on HiAP
  (Nov 2008)
• The Latvian intersectoral policy dialouge on HiAP
  (Feb 2009)

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Health impact assessment

• Health impact assessement
• Assesses the potential health impacts of pending
  decision
• Feeds the information into the decision making
  process

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ToolsThe Swedish health question

• Will the proposal promote health development for
  various groups/the population in relation to the
  social environment (e.g. opportunity to exert
  influence, mutual work and support)?
• Will the proposal promote health development for
  various groups/the population with regard to
  certain risk factors (e.g. the physical
  environment or living habits)?
• Is the proposal consistent with overall
  municipality/county health targets and
  objectives?

http//www.lf.se/hkb/engelskversion/healthquestion
.htm
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Governance tools

• Inter-sectoral structures e.g. joint committees
• inter-sectoral health councils
• audits of public administration (subject to those
  undertaking the audits being attuned to health
  impacts and the links between health and other
  policy areas)
• new strategies and programmes that cut across
  policy areas to integrate health into wider
  government action
• inter-ministerial working groups for developing
  legislation
• through land-use planning
• budget and planning processes of governments
  overall and of individual ministerial
  departments
• national and international requirements e.g.
  national environment and health action plan
• individual actions of officials to influence
  other policies or to challenge if health is
  missing as a consideration for some policies
• government memoranda
• staff appraisal and review systems that include
  an assessment of an individuals performance
  against consideration of cross-cutting policies
  such as health
• joint working groups and/or drafting procedures
• various committees including Inter-Departmental
  or Inter Ministry-Committees
• integrated appraisal or screening tools
  Inter-Departmental co-operation of strategies
  that recognize the relevance of health
• )

HIA