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Health in All Policies: an EU Literature Review 2006 – 2011 and Interview with Key Stakeholders

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Health in All Policies: an EU Literature Review 2006 – 2011 and Interview with Key Stakeholders Health in All Policies: An EU literature review 2006 – 2011 and interview with key stakeholders. Rob Howard & Stephen Gunther Specialty Registrars Public Health Final Version May 2012 This work is part of EQUITY ACTION which has received funding from the European Union, in the framework of the Health Programme. The sole responsibility for this work lies with the author 2 of 48 Tackling health inequalities – an EU priority: Parliament calls on the Council to promote efforts to tackle health inequalities as a policy priority in all Member States, taking into account the social determinants of health and lifestyle-related risk factors, such as alcohol, tobacco and nutrition, by means of actions in policy areas such as consumer policy, employment, housing, social policy, the environment, agriculture and food, education, living and working conditions and research, in keeping with the ‘health in all policies’ principle. European Parliament. Non legislative resolution 8/3/2011. ENVI/7/02651 www.health-inequalities 3 of 48 Contents Contents ............................................................................................................................................................... 3 Executive Summary .............................................................................................................................................. 5 1. Background ...................................................................................................................................................... 8 1.1 Aims & objectives ....................................................................................................................................... 9 2. Literature review. ........................................................................................................................................... 10 2.1 Search aim and strategy ........................................................................................................................... 10 2.2 Review of Health in All Policies: Prospects and potentials. (Stahl et al, 2006 (14)). .............................. 11 2.3 Literature review HiAP 2006 - 2011 ......................................................................................................... 14 2.4 Strengths and weaknesses of studies ...................................................................................................... 23 2.5 Discussion ................................................................................................................................................. 24 Leadership and politics .............................................................................................................................. 24 Governance and strategy ........................................................................................................................... 24 Partnerships and stakeholder engagement ............................................................................................... 25 Capacity and technical skills ....................................................................................................................... 25 Health equity .............................................................................................................................................. 25 Tactics ......................................................................................................................................................... 25 Culture and values...................................................................................................................................... 26 3. Interviews with key stakeholders .................................................................................................................. 27 3.1 Aim ........................................................................................................................................................... 27 3.2 Methodology ............................................................................................................................................ 27 3.3 Results ...................................................................................................................................................... 27 3.31 General ............................................................................................................................................... 27 3.32 Leadership .......................................................................................................................................... 27 3.33 Governance and strategy ................................................................................................................... 28 3.34 Partnership and stakeholder engagement ........................................................................................ 30 3.35 Capacity and technical skills ............................................................................................................... 32 3.36 Health equity ...................................................................................................................................... 32 3.37 Tactics ................................................................................................................................................. 32 3.38 Culture and values.............................................................................................................................. 34 3.39 Top tips for promoting equity focussed HiAP .................................................................................... 34 www.health-inequalities 4 of 48 3.4 Discussion ................................................................................................................................................. 35 3.41 Themes ............................................................................................................................................... 35 3.42 Limitations .......................................................................................................................................... 36 4. Conclusions .................................................................................................................................................... 38 5. References ...................................................................................................................................................... 39 Appendix 1. WHO Regional Office for Europe: A checklist of key principles for reviewing examples of practice. ......................................................................................................................................................... 42 Appendix 2. Interview proforma. ....................................................................................................................... 43 Appendix 3. Interviewees. .................................................................................................................................. 47 Appendix 4. Definition of Terms ........................................................................................................................ 48 www.health-inequalities 5 of 48 Executive Summary The first part of this report is a literature review undertaken during July 2011. It identifies opportunities and barriers for the implementation of HiAP in the countries of the EU. The second part is a report from semi-structured qualitative interviews with key stakeholders conducted during September and October 2011. This combined report was presented to a meeting of the Equity Action Work Package 4 meeting on 14 November 2011. This executive summary highlights the key findings from the literature review and qualitative interviews. It identifies opportunities and barriers for the implementation of HiAP in the countries of the EU. Seven key themes emerged and top tips for implementing HiAP more successfully across the EU were identified. 1. Leadership Explicit political commitment to HiAP at the highest possible level is a pre-requisite for success. Health systems need to show leadership in advocating for health and the HiAP approach. This is an essential starting point for the whole approach. 2. Governance and strategy It is advantageous to have an overarching high level strategy that specifically endorses HiAP approach. This can help to overcome divisions when there are apparent conflicting objectives between sectors. It can help to identify common aims across government, and support the use of resources to implement HIAs and a wider HiAP approach. 3. Partnership and stakeholder engagement Working effectively with a wide range of partners is essential. Including stakeholders by using a community participation approach is a critical factor in a successful HiAP approach. However in practice partnership working is largely seen as a local rather than national priority and there is some concern about working with both private and community sectors. 4. Capacity and technical skills Building skills and capacity both within and external to the health sector is seen by most as essential to the development of HiAP. Although technical skills were recognised as important capacity and capability issues, stronger emphasis was placed upon the need for the softer skills. These are needed to influence OGDs and other sectors, to resolve conflicts, and to raise awareness of health equity. 5. Health equity The lack of success in incorporating health equity
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