THE POLITICS AND PROSPECTS FOR HEALTH IN ALL POLICIES - FINNISH EXPERIENCES Meri Koivusalo, LT, MSc Senior Researcher

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1 THE POLITICS AND PROSPECTS FOR HEALTH IN ALL POLICIES - FINNISH EXPERIENCES Meri Koivusalo, LT, MSc Senior Researcher Esityksen nimi / Tekijä 1

2 WHAT KIND OF AN ANIMAL IS HIAP? A Health in All Policies (HiAP) approach emphasizes that public policies and decisions made concerning policy areas other than health (e.g. transport, agriculture, education, employment etc.) have the most impact on citizens health, on health determinants and on the capacity of health systems to respond to health needs Esityksen nimi / Tekijä 2

3 NOT JUST INTERSECTORAL ACTION To integrate health considerations into policies concerning sectors other than health, but as well to: Inform the policy-makers working in and across all sectors, politicians and the public about how policy decisions affect health and health systems, including the distribution of health and equity in health systems Esityksen nimi / Tekijä 3

4 OR HEALTH IMPACT ASSESSMENT HIA is a means/tool for achieving health in all policies, but not the only means Provide information and evidence from a health policy perspective at the level of governance where policy decisions are made Esityksen nimi / Tekijä 4

5 NOT JUST ANOTHER FORM OF HEALTH EDUCATION HIAP benefits and contributes to health promotion efforts on particular causes or integration of these into other sectors, but it is meant to tackle structural and political challenges in decision-making Ensure all sectors and levels of government are more accountable for policy decisions affecting health and health systems Esityksen nimi / Tekijä 5

6 JUST ANOTHER TICK IN THE BOX? Health in All policies requires understanding i) policies in other sectors ii) their relationship with health and health systems Check lists and decision trees or joint committees are often important for introduction and continuity "Do not harm" - or "medicalize" Esityksen nimi / Tekijä 6

7 POLICY AND ACTION Kingdon (1984) has explained complexities of policy-making on the basis of model of three streams: Problem Stream: There needs to be a problem or issue for development of a policy Policy Stream: There needs to be a policy that serves as a response (e.g. means to tackle the problem through a policy) Politics Stream: Political events, bargaining processes, power relations and priorities define what can be gained to the agenda The three streams to coincide for action Esityksen nimi / Tekijä 7

8 ACCOUNTABILITY AND PARTICIPATION HiAP focus on democratic accountability of policy-makers at the level where key decisions are made Performance accountability often a challenge for HiAP as targets and tasks are made narrow Participation as public participation and complementary to democratic accountability Citizens' interests/interest groups/lobbying Esityksen nimi / Tekijä 8

9 HOW CAN HIAP BE REALISED Different policies require different means and focus: strategic choice Critical mass and capacity to work together and support other sectors Local focus and starting requires national level support, training and guidance Contents matter: clear focus on substance (e.g. nutrition) or population group (e.g. aging, youth) can give a more balanced basis for co-operation Esityksen nimi / Tekijä 9

10 TOOLS AND MEANS Variety of tools and means: Health impact assessment Policy review and assessment ("health lens analysis") Issue-based committees and boards Audit reviews and scrutiny processes well-being reports as part of policy-making participatory processes contracting background studies, analysis and advice Esityksen nimi / Tekijä 10

11 FINNISH LESSONS LEARNED FOR HIAP? National disgrace due to high NCD mortality community-based public health measures North Carelia -project Structural health policies since 1970s' determinants of health defined outside health sector "McKeown, Lalonde/Canada Building healthy public policy Leppo and Melkas 1988 National disgrace due to high alcohol mortality Alcohol main cause of death for working-age population, but despite all evidence limited action Esityksen nimi / Tekijä 11

12 NCD:S AND DECLINE OF MORTALITY Esityksen nimi / Tekijä 12

13 TRIGGERS FOR ACTION STRATEGIC THINKING -Major impacts, mutual interests, missed opportunities(3m) REQUIREMENT FOR A TASK Reviews and well-being and public health reports, focal points, thematic programmes and committees focal point, senior level engagement EMERGING CONCERN AS TRIGGER FOR ACTION Aging programme : health sector as part of joint cooperation with focus on mobility, physical and social wellbeing CRISIS/FAILURE AS TRIGGER FOR BROADER ACTION Traffic accidents and transport planning School shootings as background for increased intersectoral work on security Esityksen nimi / Tekijä 13

14 HIAP AS A LEGAL OBLIGATION Assessment of human impact assessments as part of legislation on environmental impact assessment (267/ ) Public Health Act (2005/928, 4 ) public health tasks are surveillance and follow up of population health and determinants of population health, taking care that health is taken into account in all policies in municipal decisionmaking and collaboration with other public and private actors for health promotion 2010 Health care act reinforces obligations, but implementation, follow up and oversight remain issues Esityksen nimi / Tekijä 14

15 FINLAND - LOCAL GOVERNMENT ACTION Kauppinen (2011) study on use of human (health and social ) impact assessments (ex ante): depend on cultural, organisational and professional attitudes use for decision-making had been minor consideration easier when not in conflict with economic arguments lack of resources and limits in economic policy space often act against assessment sense of professional limits and lack of capacity for assessment Esityksen nimi / Tekijä 15

16 CHALLENGES The most heard response to questions on human impact assessment in local governments was: "Is not applied, we have not done it before, it is not compulsory and we do not have skills and capacity to do that" HIAP at national level: public health reporting, interministerial committees, issue-based committees Competing assessment procedures for business impacts; increasing demands from health sector for contribution to competitiveness, innovation and growth Esityksen nimi / Tekijä 16

17 POLICY SPACE FOR HEALTH Health in all Policies includes the understanding that "health" in health policies needs to be maintained Financial crisis in the 1990s changed context: Killing of initiatives by mainstreaming without resources and capacities : everybodys' business becomes no ones business Trickling down of responsibilities without resources Health services as commercial services and means for economic growth Emphasis on improving efficiency, productivity and performance: more management, less public health Esityksen nimi / Tekijä 17

18 ENSURING HEALTH IN HEALTH POLICIES? HIAP requires shift in focus and understanding policies and politics in other sectors: critical mass and focal point Tackling win-win options is a beginning, but local level action requires support and backing Impact of other policies upon aims and priorities upon health systems, health policies and policy space for health European Union and its role in better and smart regulation and impact assessment, internal markets, government procurement, trade agreements Productivity, public management and performance targets Esityksen nimi / Tekijä 18

19 HIAP AND EUROPEAN LEVEL Health considerations can be included as part of local policies in the context of government procurement Communicating local needs for policy space to the European politics and policy agenda Structural funds use for health and reduction of health inequalities future? EU Council conclusions on Health in All Policies in 2006 Scope for learning and cooperation across countries Esityksen nimi / Tekijä 19

20 Thank you If you wish to ask more or need further information, please Esityksen nimi / Tekijä 20