Opportunities for Scaling up and Strengthening the Health-In-All-Policies Approach in South-Eastern Europe

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Opportunities for Scaling up and Strengthening the Health-In-All-Policies Approach in South-Eastern Europe Opportunities for scaling up and strengthening the health-in-all-policies approach in South-eastern Europe Abstract As an approach, Health in All Policies (HiAP) has been recognized in major European resolutions, charters and communications, treaties, frameworks and action plans. This report aims to gauge opportunities for scaling up and strengthening a HiAP approach in 9 of the South-eastern Europe Health Network (SEEHN) countries. It is based on a review of materials prepared by SEEHN member countries’ representatives for the Third Health Ministers Forum, “Health in All Policies in South-eastern Europe: A Shared Goal and Responsibility”. An overview is followed by detailed country-specific studies of current policy, and challenges, opportunities and recommendations for strengthening HiAP. Adopting a HiAP approach is an effective approach to addressing the root causes of ill-health and improving equity in the region. Firstly, at a time of economic crisis, it is economically sensible to pool resources with other sectors to address common challenges, secondly, it demonstrates how improving health contributes to the attainment of wider objective such as poverty reduction, inclusive growth and community wellbeing, thirdly it can improve the performance of health and social care systems and make them more sustainable. Across the region there is strong political will to support HiAP, progress is being made to strengthen instruments and capacity and examples of promising practice exist. The SEEHN offers an opportunity to build on existing work, .share learning to date and strength action for health and development with other sectors. There is however, more work to be done to scale-up and improve the capacity and performance of HiAP in the region. Areas for action include a stronger focus on equity and systematically addressing the determinants of health, improved systems of intelligence for health and social care systems and further training and instruments for policy makers and health professionals. This work must be supported by continued political and financial support and further development of networks for implementation. Key words PUBLIC HEALTH HEALTH INEQUITIES HEALTH IN ALL POLICIES INTERSECTORAL COOPERATION HEALTH BEHAVIOUR HEALTH IMPACT CAPACITY BUILDING REGIONAL COOPERATION SOUTH-EASTERN EUROPE HEALTH NETWORK SOCIAL DETERMINANTS OF HEALTH © World Health Organization 2013 All rights reserved. This information material is intended for a limited audience only. It may not be reviewed, abstracted, quoted, reproduced, transmitted, distributed, translated or adapted, in part or in whole, in any form or by any means. Executive summary HiAP in South-Eastern Europe As an approach, Health in All Policies (HiAP) has been recognized in major European resolutions, charters and communications, treaties, frameworks and action plans, and the approach will be an important goal of the new European Policy for Health, Health 2020, and the European Action Plan for Strengthening Public Health. HiAP was selected as the focus of the Third Health Ministers’ Forum of the SEEHN. This report aims to gauge opportunities for scaling up and strengthening a HiAP approach in 9 of the SEEHN countries (Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Republic of Moldova, Romania, Serbia and The Former Yugoslav Republic of Macedonia). It is based on a review of materials prepared by SEE Health Network member countries’ representatives for the Third Health Ministers Forum, “Health in All Policies in South-eastern Europe: A Shared Goal and Responsibility”. The report takes account of the political, social and economic aspects of each country, and then analyses the policy frameworks, mechanisms and tools available for HiAP approaches, as well as the information available for advancing HiAP and capacity building to support them in the future. An overview is followed by detailed country-specific studies of current policy, and challenges, opportunities and recommendations for strengthening HiAP. Agreed terms and concepts Countries may use different terms to refer to HiAP, and terms may be conceptualized differently. It is necessary to agree on the frameworks to be used, the common terms and concepts and the criteria for the assessing process. One aim of this study has been to agree on definitions and language, so that experience and evidence accumulated in south-eastern Europe can be used in all regions and by all countries. Addressing the social determinants of health and equity A HiAP approach recognises the importance wider social, economic and environmental factors have on our health. Inequalities in health are rooted in the social determinants of health, that is, the conditions in which people are born, grow, live, work and age, including the health system. They are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy and governance choices. The European Policy for Health focuses on many of the themes and issues that are at the core of the Health in All Policies approach and underpin actions to address health inequities. It identifies how health and well-being can be advanced, sustained and measured through actions that enable improved and fair daily living conditions and result in healthier environments, social cohesion, security, work-life balance and good education. Most countries in the region have falling populations, with positive annual growth rates in only three of the nine countries. The leading causes of mortality and years of life lost in all countries are non- communicable diseases, which reach over 80% per cent of years of life lost in most countries, and in the two countries where it is slightly lower, there is a high rate of life years lost through accidents. Infant mortality has declined in all countries, but only three countries have single-digit rates per 1000 live births. There is a strong link between these current health challenges and the social and economic conditions within counties, where the effects are mediated (amplified or mitigated) by prevailing norms and values in society. This has a major impact on health equity within and between countries. Countries have different approaches to addressing health equity. Many small scale, time limited projects exist but understanding what works and scaling up action to sustain impact remains a challenge. Macro policy approaches vary from those that seek to provide social benefits to the entire population as a basic right, while others target specific social groups or territories and use means tests to determine eligibility. This is the most commonly used approach. Such groups can be those on low incomes, children and women, the socially excluded and groups with greater risk of certain health problems. The main social determinants are access to appropriate and affordable health services, education and social protection, poor quality and affordable living conditions such as housing and water sanitation, limited income and employment opportunities and discrimination. These in turn strongly influence lifestyle opportunities and behavioural choices as well as levels of social cohesion. Policy-making systems and structures Information on the administrative and political organization of the country can identify whether there is current integration of health and wider policy. Understanding the organization of the government and the formal and informal social participation and coordination of the whole government is important for identifying opportunities and possible barriers with respect to a HiAP approach. Existing cooperation exists across the region. Education, followed by social protection, was identified as having good or very good relationships with the health sector in eight of the country studies. Positive intersectoral relationships were cited with employment and environment in six of the studies. Effective relationships with the agricultural sector were cited in five of the nine country studies, yet some countries with comparatively large rural populations have indicated low levels of cooperation with agriculture. Studies suggested that the ministry of finance is a particular sector with whom countries reported a need for cooperation but where it is currently underdeveloped. Policy frameworks in the countries present a diversity of opportunities for multi-sectoral activities. Several countries identify their recent national and local planning and development plans as HiAP development opportunities. There are many strategies directed at particular groups or issues that provide a basis for intersectoral responses. Across the SEEHN countries these include plans related to gender equity and/or domestic violence, poverty reduction, social inclusion and the Roma minority, early child development, the environment, climate change, agriculture and illicit drugs. All countries emphasize how regional and international developments in HiAP influence opportunities for scaling up HiAP actions in SEE, underlining the importance of support by the European Commission, WHO and other multilateral entities. Multi-sectoral working groups, such as the Joint Planning Mechanism, are present in most countries, mainly associated with specific ad hoc targets or issues. Most of them have a time-limited duration and their composition varies according to the discussed topic. The second identified mechanism is joint assessments, which are associated with specific plans or programmes, for example in the assessment
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