HIA Implementation and Challenges for Switzerland

Transcription

1 Implementation and Institutionalisation of HIA in a Federalist Country: Opportunities and Challenges for Switzerland HIA 11 In times of crisis, healthier ways Granada April 2011 Dr. Jean Simos Nicola Cantoreggi Research Group on Environment and Health University of Geneva 1

2 Swiss Health System 7,7 millions people, 4 National languages, 22% foreigners diversity Federal (political system) = 26 cantonal+1 national Health Systems Organisation, structures, facilities management: canton level 2

3 Swiss Health System (2) Health and accidents Insurance, specific issues (e.g. epidemiology and infectious diseases, substance abuse and drug prevention, stem cell research and bioterrorism, noise and radiation protection): federal level Health Promotion at the federal level: No other legal basis than that for a national foundation (Health Promotion Switzerland) Federal law on the way (but strong opposition ) Health Promotion at the canton level: Included in canton s Public Health Act Specific actions in fields where are loopholes in federal level, e.g. prevention of non communicable & mental diseases 3

4 In this context, what strategy to promote HIA? How a bottom-up approach and a top-down approach could be combined to strengthen HIA implementation and institutionalization, at different territorial levels? Is there room for HIA at local (cantonal) level? Is a bottom-up approach to promote and disseminate HIA feasible? What opportunities should one take and what challenges should one face? 4

5 Opportunities Cantons are legitimate to introduce and experiment HIA at local level i.e. Geneva, Jura and Ticino Organisational design of HIA is locally agreed, i.e. it is coherent with available resources and political-administrative options (legislate first VS experiment first) i.e. Geneva: legislative approach, Jura/Ticino: experimental approach 5

6 Experiences and best practices could be shared and disseminated at little costs through supra-cantonal fora e.g. Swiss Platform on HIA, National Health Promotion Conferences Other cantons, not yet involved, could select organisational and institutional options which fit at best to their own specificities VS mandatory, not specific and costly institutional design imposed by a federal law 6

7 Challenges The minority groups legitimacy is under scrutiny i.e. communities clichés in Switzerland Governance fragmentation multiplies the level of cross-examination of a proposal the day the Federal Health Minister upheld HIA into the new federal Law proposal on Health promotion and prevention Potential serious hinder when a given authority disagree with it but more entry points for advocacy and lobbying 7

8 How do we operate? Promotion and dissemination of HIA during national events and through bilateral contacts with cantons (activity funded by Health Promotion Switzerland since 2009) concerning: Swiss HIA Platform activities and deliverables Activities engaged in other Francophone countries (France, Belgium, African countries) Activities engaged at international involving Swiss HIA actors level (GWGHIA, HIA conferences) 8

9 How do we operate? Bottom-up intensive advocacy and lobbying for HIA at federal level: through convinced Health promotion public servants in cantonal health administration from them, through cantonal Health Ministers, gathered into the Association of Cantonal Health Ministers through activities within Swiss Parliament: Elected representatives (from all parties), members of the Health Commission opinion leaders at the Swiss Parliament 9

10 Swiss HIA Platform activities and deliverables Information about HIA to the other cantons Implementation by pilot study-cases Communication: website, newsletters, Guide Training courses (e.g. Summer School) Advocacy for administrative and political decision makers ( argumentaire, fact sheets) 10

11 Current situation New Health Promotion Law, which included HIA (with non-mandatory clause) is currently discussed at Swiss Parliament HIA implementation at Federal level is facing internal opposition because of a perceived concurrence with others assessment tools (i.e. sustainability) HIA at Cantonal level is gaining legitimacy but its implementation suffers from budgets reductions 11

12 Open questions Will a multi-level implementation of HIA boost its dissemination as a priority tool to materialize a health in all policies approach? Is a strongest regulatory involvement (cf. EIA, top-down approach) of the Federal level conceivable and feasible? Within current public finances crisis, is it possible to tackle the pervasive mantra: there are too many assessment tools on the market: let s integrate all of them!? 12