EUR/00/5016448 ENGLISH ONLY UNEDITED E70851 Investment for health A demonstration project in West Saxony, Germany Dr Rüdiger Krech Telephone: +45 39 17 12 69 Acting Regional Adviser Healthy Aging European HEALTH21 target 6, 9, 13, 14 2000 EUROPEAN HEALTH21 TARGET 6 IMPROVING MENTAL HEALTH By the year 2020, people’s psychosocial wellbeing should be improved and better comprehensive services should be available to and accessible by people with mental health problems (Adopted by the WHO Regional Committee for Europe at its forty-eighth session, Copenhagen, September 1998) EUROPEAN HEALTH21 TARGET 9 REDUCING INJURY FROM VIOLENCE AND ACCIDENTS By the year 2020, there should be a significant and sustainable decrease in injuries, disability and death arising from accidents and violence in the Region (Adopted by the WHO Regional Committee for Europe at its forty-eighth session, Copenhagen, September 1998) EUROPEAN HEALTH21 TARGET 13 SETTINGS FOR HEALTH By the year 2015, people in the Region should have greater opportunities to live in healthy physical and social environments at home, at school, at the workplace and in the local community (Adopted by the WHO Regional Committee for Europe at its forty-eighth session, Copenhagen, September 1998) EUROPEAN HEALTH21 TARGET 14 MULTISECTORAL RESPONSIBILITY FOR HEALTH By the year 2020, all sectors should have recognized and accepted their responsibility for health (Adopted by the WHO Regional Committee for Europe at its forty-eighth session, Copenhagen, September 1998) ABSTRACT Keywords REGIONAL HEALTH PLANNING FINANCING. HEALTH SOCIOECONOMIC FACTORS ENVIRONMENTAL HEALTH INTERSECTORAL COOPERATION CONSUMER PARTICIPATION GERMANY © World Health Organization – 2000 All rights in this document are reserved by the WHO Regional Office for Europe. The document may nevertheless be freely reviewed, abstracted, reproduced or translated into any other language (but not for sale or for use in conjunction with commercial purposes) provided that full acknowledgement is given to the source. For the use of the WHO emblem, permission must be sought from the WHO Regional Office. Any translation should include the words: The translator of this document is responsible for the accuracy of the translation. The Regional Office would appreciate receiving three copies of any translation. Any views expressed by named authors are solely the responsibility of those authors. This document was text processed in Health Documentation Services WHO Regional Office for Europe, Copenhagen CONTENTS Page Aim of this report ............................................................................................................................1 1 Overview of West Saxony investment for health demonstration project.................................1 1.1 Introduction.....................................................................................................................1 1.2 Background on the West Saxony region and eastern Germany......................................2 2 Overview of investment for health concept and principles......................................................3 2.1 Background and significance..........................................................................................3 2.2 Principles.........................................................................................................................4 2.3 Application of these principles: the real challenge .........................................................5 3 How investment for health was put into operation in West Saxony ........................................5 3.1 Developing a health-promoting infrastructure................................................................5 3.2 Political and administrative support................................................................................6 3.3 The individual projects and the umbrella group .............................................................7 3.4 Organizational development and action learning............................................................8 4 Lessons learned from the project..............................................................................................9 4.1 The process and management of the project...................................................................9 4.2 Local, regional and national commitment, capacity and sustainability ........................12 5 Future directions for investment for health ............................................................................21 5.1 Securing investment for health .....................................................................................21 5.2 A multi-level, intersectoral political infrastructure.......................................................22 5.3 Mobilizing broad, representative participation by the local population .......................22 5.4 Moving beyond traditional epidemiology-oriented data...............................................22 5.5 Local, regional and national capacity to invest for health ............................................22 Annex 1. Short descriptions of the individual projects.................................................................24 Acknowledgements We would like to thank those people who made the investment for health project in West Saxony possible: Professor Alfred Rütten for the daily work as the local counterpart, Professor Laurie McMahon from the Office For Public Management in London for his assistance in facilitating the Umbrella Group work, Kai Rudat and Dr Nora Groce for their valuable contribution in the area of community participation, and Professor Lowell Levin for his continuous technical assistance. Finally, we wish to extend our special thanks to Pamela Nelson who, as a graduate from Yale University and intern in WHO, did her field study in Saxony and was instrumental in preparing this report. Copenhagen, October 2000 Dr Erio Ziglio Dr Rüdiger Krech Regional Adviser Acting Regional Adviser Social and Economic Determinants Healthy Aging EUR/00/5016448 page 1 Aim of this report This report gives a brief overview of the background to and the structures and processes involved in the investment for health demonstration project in West Saxony. It describes some observations and concentrates on the lessons learned from the project for the benefit of the West Saxony region, as well as other interested policy-makers, managers, politicians and professionals in WHO European Member States and other governments worldwide. It also suggests a potential future direction for the investment for health approach for West Saxony to consider. The report is divided into five sections. Section 1 provides some background on West Saxony. Section 2 gives further depth on the concepts and principles upon which the project was based, as well as the significance of the approach to the current and historical political economy of Saxony. Section 3 gives more detail on how the approach was introduced and put into operation in Saxony, including the steps taken to develop the necessary health-promoting infrastructure. Section 4 identifies some of the key lessons learned from the experience, many of them relevant both to the overall project and the individual communities, and also lists possible next steps. Section 5 offers potential future directions and development needs for this project. 1 Overview of West Saxony investment for health demonstration project 1.1 Introduction The investment for health demonstration project in the West Saxony region of Germany brought together nine towns facing similar social, economic, demographic and environmental problems. It began when the Technical University of Chemnitz-Zwickau, representing a growing network of towns and organizations in West Saxony, asked the WHO Regional Office for Europe to help them explore strategies to address some of their most pressing development challenges. Working closely with WHO and other partners, the region’s initial concept evolved to the ultimate overarching goal of developing a “healthy region” by focusing on integrated social, health and economic development. Each town addressed related issues through distinct demonstration projects, and the overall project developed skills and experience that helped all participants to identify and address common issues better in four main areas: • community engagement • building alliances • securing investment • creating and sustaining health. It also brought the individual communities together as a single, more powerful entity in an attempt to define and secure a healthier future for their region. The West Saxony investment for health project is particularly important for several reasons: • Economies in transition have experienced dramatic and often devastating changes not only in economic conditions, but also in their social fabric and health status. Although the magnitude of the health consequences in eastern Germany does not compare to other former eastern bloc nations, it is still significant. Through intersectoral work and cooperative planning, this EUR/00/5016448 page 2 project developed practical tools and approaches to begin to address the multiple determinants of health on which there has been an impact in these economies. • Despite the major financial investment that eastern Germany has received from its western counterparts since 1990, the need to rebuild social, economic and environmental resources persists. This project explored potential approaches and began to accumulate an evidence base to show which needs